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Use Church Code “180” when you register!

Registration Form

Team Manager Information: *

• Qualifications: A team manager must be 18 years of age or older. This could include a parent, coach, mentor, or participating player of age.

Please check the box to verify you understand the above information.

Once registered: *

• The team manager is the primary point of contact for the registering team prior to the event. The team manager must be present for check-in on the day of the selected event. The team manager is the responsible party of all persons on the registered team during the duration of the Urban Roundball Classic event. If the team manager cannot be reached in the event of an emergency, the Urban Roundball Classic staff will then contact the secondary contact for the player in need of emergency assistance (if listed). If the secondary contact is not listed, or cannot be reached, a medical professional will be contacted.

Please check the box to verify you understand the above information.

LOCATIONS *

• FLINT

Only one location per registration form

DATES *

• AUGUST 13, 2022

Only one date per registration form

Age Group *

• Elementary (ages 8-11)
• Middle School (ages 12-14)
• High School (ages 15-18)

Team Manager’s Name *

First

Last

Manager’s relation to team *I am a parent of a player(s)I am the coach of a player(s)I am a mentor to a player(s)I am a player on the team (18+)Other

Please specify *

Other relation to a team member or members

Manager’s Email *

Manager’s Phone *

Please select the desired registration type to continue: *

• I am registering an individual player
• I am registering a team (Must have all participating players’ information)

Player’s Name *

First

Last

Birthdate *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Secondary Contact (optional)

First

Last

Secondary Contact Phone

Team Name *

Player 1 Name *

First

Last

Player 1 Birthdate *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

P1 Secondary Contact (optional)

First

Last

optional

P1 Secondary Contact Phone

optional

Player 2 Name *

First

Last

Player 2 Birthdate *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

P2 Secondary Contact (optional)

First

Last

optional

P2 Secondary Contact Phone

optional

Player 3 Name *

First

Last

Player 3 Birthdate *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

P3 Secondary Contact (optional)

First

Last

optional

P3 Secondary Contact Phone

optional

Player 4 Name (optional)

First

Last

Player 4Birthdate (optional)MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

P4 Secondary Contact (optional)

First

Last

optional

P4 Secondary Contact Phone

optional

Check to Agree *

• I understand each team must be represented by a manager over the age of 18

Check to Agree *

• I verify that this information is correct and accurate, and acknowledge I may be disqualified from playing in the tournament if my information is found to be inaccurate.

Waiver Consent *

• I hereby acknowledge that inherent risks are associated with and accompanied by the activities involved in the Urban Roundball Classic 3v3 Basketball Tournament at the Detroit, Pontiac, or Flint event sites. In consideration for the registered player to participate in the 180 Church’s Urban Roundball Classic event, the undersigned releases and hold harmless 180 Church and/or its employees, staff, volunteers, contractors, partners, administrators, officials, teachers, coaches, etc. from all liability, including, but not limited to, the liability of injury or any damage sustained by the registered player.

Submit