TOURNAMENT REGISTRATION

Please use this form for all team registrations.

Adult Teams Max Roster: 14
Cost: $1120

Youth Indoor Teams Max Roster: 10
Cost: $900

Division

Team Name

Team Captain Name	Email

Team Captain Address	City, State, Zip

Team Captain Home Phone	Work Phone

Team Captain Cell Phone	Fax Number

Player Cards Required at all Adult Games

Signed Code of Conduct Required on file for adult players.

	Team Roster
	Player Name	Date of Birth	Contact Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14

Payment Information
CC #s are Encrypted
Amount
Credit Card No
Expiration	/
Privacy Code	(last 3 digits from the back of the card)

- Credit Cards are Encrypted, however you may call 936-321-1001 ext. 231 to submit your credit card # -

WAIVER OF LIABILITY AND RELEASE AGREEMENT

I hereby release, discharge and/or otherwise indemnify JOPA Sports, its employees and associated personnel, including the owners of arenas and facilities utilized by the programs, against any claims by or on behalf of the registrant as a result of the registrants participation in the program and or being transported to or from the same, which transportation I hereby authorize. As the parent/guardian of the above named player, I hereby give consent for emergency medical care prescribed by a duly licensed doctor of medicine. This care may be given under whatever condition necessary to preserve the life, limb or well being of the dependent. I hereby give my approval and consent to both statements.

IMPORTANT!
By registering, you indicate that you have read
and understand the above waiver.

Team Roster

Payment Information

WAIVER OF LIABILITY AND RELEASE AGREEMENT