Parent/Guardian #1 Name *

First Name

Last Name

Parent/Guardian #1 Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian #1 Phone *

(###)

###

####

Parent / Guardian #2 Information

Parent/Guardian #2 Information is OPTIONAL. Please skip to "Emergency Contact" section if this does not apply.

First Name

Last Name

Parent / Guardian #2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent / Guardian #2 Phone

(###)

###

####

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Gender *

Male

Female

Prefer Not to Say

Jersey Size *

Small

Medium

Large

X-Large

Skill Level *

Beginner

Intermediate

Advanced

Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Gender

Male

Female

Prefer Not to Say

Jersey Size

Small

Medium

Large

X-Large

Skill Level

Beginner

Intermediate

Advanced

Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Gender

Male

Female

Prefer Not to Say

Jersey Size

Small

Medium

Large

X-Large

Other

Skill Level

Beginner

Intermediate

Advanced

Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Gender

Male

Female

Prefer Not to Say

Jersey Size

Small

Medium

Large

X-Large

Other

Skill Level

Beginner

Intermediate

Advanced

Coach / Assistant Coach *

This is a volunteer coach league. Please sign-up to coach. *** Note: All coaches are required to submit a background check.

Yes

No

Team Manager *

Would you like to be a Team Manager Volunteer? Duties include: team support, communications, snacks, sideline help.

Yes

No

How did you hear about KOPPS? *

Word of Mouth

Social Media

Internet Search

Referral

Terms and Services *

Registration Membership Liability Agreement: IN CONSIDERATION OF my child/ward being allowed to participate in any way in the Kids Opportunities to Succeed, Inc. (KOPPS) related events and activities, the undersigned acknowledges, appreciates, and agrees that: The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) to my child/ward from the activities involved in these programs are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and, 1. FOR MYSELF, SPOUSE, AND CHILD/WARD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child’s participation; and, 2. I warrant that my child/ward is in good health, has no condition or defect which would interfere with his/her participation; and, 3. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s/ward's readiness for participation and/or in the program itself, I will remove my child/ward from the participation and bring such attention of the nearest official immediately; and, 4. I myself, my spouse, my child/ward, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS National Junior Basketball League, Inc.; NJB local chapters; their directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 5. I, for myself, my spouse, my child/ward, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. 6. I, the parent/guardian, assert that I have explained to my child/ward: the risks of the activity, his/her responsibilities for adhering to the rules and regulations, and that my child/ward understands this agreement. I, FOR MYSELF, MY SPOUSE, AND CHILD/WARD, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. CONCUSSION/INJURY AGREEMENT EXPECTATIONS OF PLAYERS, PARENTS AND COACHES: Player - If you sustain a blow to your head, fall down and hit your head, or any other injury, you will report it to your coach whether it is a KOPPS activity or not. This way KOPPS is aware of it. Before returning to play or practice, your parent shall communicate with your coach. If you go to a doctor to treat an injury including a concussion, KOPPS needs a note from your doctor stating you are clear to play or that explains your limitations and a "return to active status" date. Coach - If a player sustains an injury or hits his/her head, he/she shall not continue to play or practice until a certified athletic trainer or medical doctor states that he/she can. In addition, any blow to the head, concussion, and possible concussion shall be reported to the player’s parent as soon as is practicable. Parent - If your player sustains a blow to his/her head or any other injury, you will report it to the coach whether it is a KOPPS activity or not. This way KOPPS is aware of it. Before returning to play or practice, you shall communicate with the coach. If your player goes to a doctor to treat an injury including a concussion, KOPPS needs a note from your doctor stating he/she is clear to play or that explains his/her limitations and a "return to active status" date. We encourage to read and help your child understand abuse awareness for compliance to the Safe Sport Act below: Abuse Awareness Training for Minors (Ages 4-12) Abuse Awareness Training for Minors (Ages 13-17) If your child/ward sustains a blow to his/her head or any other injury during the season, whether during an KOPPS event or outside of KOPPS, you must report it to the coach. If your child seeks medical attention for any injury, including a concussion, you must get a medical clearance form from an MD or DO stating that your child/ward has been cleared for full activity and you must present this to your child's/ward's coach prior to return to participation. Here is a link to our Brain Injury / Concussion risk management plan which includes our policies and educational training for our administrators and staff but parents should be familiar with it as well:Sample Brain Injury/Concussion Risk Management Program Photography Agreement I grant to KOPPS, its representatives and employees the right to take photographs of me and my property in connection with the above identified subject. I authorize KOPPS, its assignees and transferees to copyright, use and publish the same in print and/or electronically. I agree that KOPPS may use such photographs of me without my name for any lawful purpose, including such purposes as publicity, illustration, advertising and Web content. Child Abuse / Molestation Risk Management Plan Here is a link to KOPPS Child Abuse Risk Management Plan which is required by the federal Safe Sport Act and includes our policies and educational training: Below are the links to our Child Abuse Minor Training plan which KOPPS is required to provide by the federal Safe Sport Act. I will review and explain this information to my minor child as I deem appropriate. Abuse Avoidance Training For Minors Ages 4-12 Abuse Avoidance Training For Minors Ages 13-17 By registering and selecting the I agree button below, you have agreed to the following: 1. I have read, understand, and agree with the refund policy as stated above. 2. I have read, understand, and agree with the waiver/release agreement above which applies to injuries and communicable diseases such as COVID-19. I have also explained this waiver/release to my child ward including the risks of participation and he/she understands this risk and his/her respective responsibilities for adhering to the rules and regulations and accepts them as a participant. 3. I have read, understand, and agree with the image release agreement. 4. I have read, understand, and agree to adhere to the KOPPS Brain Injury / Concussion Risk Management Plan and my requirements for notification, to seek medical treatment, and to obtain written medical clearance before my child/ward can return to activity. 5. I have read, understand, and agree to adhere to the KOPPS Child Abuse Risk Management Plan including the minor training recommendation.

I have read, understand, and agree to the terms and conditions.

Option 2