Rep Program Registration Form

Please Note: 

Payment for the first semester will be due upon the first official practice.

Child Name *
Child Name
Age Group *
Select one of the following age groups
Please include Postal Code!
By selecting 'Agree', I hereby certify that my child is in reasonable health and is capable of safe participation in the program selected. I assume all risks and hazards incidental to the conduct of this program. I hereby release Western City Basketball, its employees, and its board, from any and all causes of action and or claims for any physical injuries, personal losses, or damage done to personal property while on the premises of either Western City Basketball, or properties associated with specific programs of the organization. I agree to indemnify and save harmless Western City Basketball from any claims or demands arising out of any such injuries or losses. I authorize the publication of any photography taken for or during this program for the use of promoting or advertising further programs, unless I notify Western City Basketball, of my desire to not permit any published photos at the time of registration.