HOW DO I SIGN UP?
Register Online, Mail
or Bring Information To:
Pine Glen Alliance Upward
PO Box 168
McVeytown, PA 17051-0168
Register online by clicking here OR mail paper registration and
fee to the address noted above.
Make checks payable to: Pine Glen Alliance Church
add to Memo: Upward
Early bird registration fee per child is $56; after October 23, the fee
is $64. Registration deadline is November 19 at 11:00 am.
Multi-child discount available online for child 3 or more playing
from same household. Please contact Sherri for further info if
mailing in paper registration on 3 or more children.
Scholarships are available by contacting
Pastor Bruce Overstreet at 717-899-7740.
EVALUATIONS AND SIGN-UPS:
Everyone must attend one basketball evaluation.
These are "walk-in", between times noted below, and will take
place at Pine Glen Alliance Church as follows:
K5 through 6th Grade Boys/Girls
• Tuesday, November 15, between 6:30 p.m. and 8:00 p.m.
• Thursday, November 17, between 6:30 p.m. and 8:00 p.m.
• Saturday, November 19, between 10:00 a.m.and 11:30 a.m.
First Practice - Monday, January 2, 2017
First Game - Saturday, January 14, 2017
Awards Celebration - Saturday, March 11, 2017
FOR MORE INFORMATION:
www.pineglencma.org/Upward or Tom & Sherri Bickert
at 717-899-6999 or firstname.lastname@example.org
PLEASE READ CAREFULLY AND SIGN BELOW TO INDICATE YOUR AGREEMENT.
NOTE: THIS FORM INCLUDES A RELEASE OF LIABILITY.
Please review and complete the sections below and sign in the space provided to indicate your agreement with all statements made in such sections .
AUTHORIZATION AND RELEASE OF LIABILITY
I, the parent or guardian of the above named child, authorizes the participation of my child in the Upward Unlimited (herein being referred to as UU) athletic program (the "Program") of the above named Church. My child will participate in the UU sport denoted on this brochure. I understand that
this Program is a nonprofit Christian sports ministry program for youth and that my child's
participation is voluntary and not essential to completion of requirements of any program, school or government agency. I understand that the Program is conducted by the Church and its volunteers and staff, including parents of other participating children. I also understand that the Church is solely responsible for all aspects of the Program including selection and supervision of all persons conducting the Program, and that UU is not responsible for the Program or selecting and supervising persons conducting the Program. I further understand and agree that my child's participation in athletic and other activities of the Program necessarily involves the risk of injury and even death from various causes, including but not limited to accidents, falls, strenuous and prolonged physical activity, dehydration, illness, collision or dispute with other participants, weather related injuries , playing area and equipment defects, and negligence of coaches and referees. On behalf of my child, me, and my family, I assume these risks. In consideration of the privilege of my child's participation in the Program, and on behalf of my child and me as parent/guardian, I hereby release, discharge, hold harmless and indemnify, and covenant not to sue, the Church and UU, and all of the Church's and UU's directors, officers, elders, trustees, deacons, employees, volunteers, insurers, agents and representatives, and all other persons associated with the Program (including without limitation any other participating churches, sponsors, parents, vendors, coaches and other game and event workers, officials, drivers, and organizations) as to any and all claims of my child, me and other family members for personal injuries suffered by my child, property damage, medical expenses, and economic loss arising directly or indirectly out of my child's participation in the Program, and any first aid, medical care or treatment provided to my child in the event my child is injured or becomes ill while participating in Program activities, and excepting claims that may not be released under applica ble law. This Release of Liability shall be as broadly construed as allowed by law to include all claims and rights that the child, that I as parent/guardian, and that other family members may have. I am a legally responsible parent or guardian of my child. If any provision of this Release of Liability is deemed invalid, the remaining provisions shall remain in full force and effect. This Release of Liability shall be binding on me, my family, heirs, next of kin, legal representatives, beneficiaries, successors and assigns I hereby authorize the Church and UU to use, reproduce, distribute, display, and to license others to use, reproduce, distribute, and display, my child's image, and photograph, as well as any video, digital, or audio recording or reproduction, in connection with external and internal communications of the Church and UU for the sole purpose of advancing UU programs. I acknowledge and consent that registration will allow UU to obtain access to personal information regarding me and my child participant. I agree that UU may use such personal information in a manner consistent with UU's Conditions of Use and Privacy as amended from time to time. I further understand that the current version of UU's Conditions of Use and Privacy may be found at www.upward.org. I further acknowledge and consent that use of such personal information may involve communication by UU directly to the parent/guardian home and email addresses.
PARTICIPATION AND SAFETY
I understand that participation in the Program may involve strenuous and prolonged physical activity. I agree that my child is healthy and able to participate in the Program activities. I understand that the Church or its representatives may request health information concerning my child and/or ask my child to undergo a medical exam. If the Church determines that my child does have a physical, mental or other condition that may affect his / her ability to safely and appropriately participate in Program activities (or that may affect the ability of other children to participate safely), the Church may determine that my child cannot be permitted to participate. I understand and agree that, while the Church desires that all children will be able to participate, such decisions may have to be made out of concern for the best interests of my child and other participants.
CONSENT TO MEDICAL TREATMENT
In the event my child is injured or becomes ill in Program activities, and if I, the parent or guardian of the above-named child, am not present to make medical decisions, I hereby authorize the Church, its staff, volunteers including volunteer parent participants, coaches, assistant coaches, and referees, supervisors and drivers, to arrange for and consent on my behalf to emergency medical and dental care and treatment, including tests and radiological exams, and surgery, and hospital care and treatment, and to consent to medications for pa in and other conditions as prescribed by medical personnel attending my child. I am responsible for payment of any medical charges or expenses not covered by my insurance or the insurance applicable to my child (if any). My signature below indicates that all information provided in this form is true and accurate, and that I fully agree to all statements made on the form, including but not limited to the Authorization and Release of Liability, Medical Conditions, and Consent to Medical Treatment. My signature also indicates that all legal guardians are aware and consensual with the participation of the above-named child.