SBA REGISTRATION - The SerpNation Store

PLEASE COMPLETE THE FOLLOWING FORM TO REGISTER

The information gathered in this form will be utilized to add the registered player to our roster. If more information is needed, the registered parent will be contacted using the registered email or phone number. Contact us for further assistance: contact@volusiaserpents.com

PLAYER FULL NAME *

First

Last

GENDER *

Boy
Girl

DATE OF BIRTH *

GRADE (as of Spring 2024 Semester) *

SCHOOL *

CITY OF RESIDENCE *

JERSEY SIZE *

JERSEY NUMBER *

PARENT FULL NAME *

First

Last

PARENT PHONE NUMBER *

PARENT EMAIL *

Confirm Email

AUTHORIZED FOR PICK-UP *

Full name of any Friend or Family Member authorized to pick up your child(ren)

ADDITIONAL DETAILS

I ACKNOWLEDGE THAT I HAVE READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND IT IS A RELEASE OF LIABILITY. I FURTHER UNDERSTAND THAT BY SIGNING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS. I expressly agree to release and discharge the Volusia Serpents Basketball Academy and all affiliates, employees, agents, representatives, successors, or assigns, from any and all claims or cause of action and I agree to voluntarily give up or waive any rights that I may otherwise have to bring legal action against the Volusia Serpents Basketball Academy, for negligence (including party’s own negligence, employee’s, other patron’s and/or equipment), personal injury or property damage. By signing this release, I acknowledge that I understand its content and that this release cannot be modified orally.