Harvard Jr. Hornets Basketball — Player Registration

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Registration Notice

1 Program & Registration

Select Program

🏀 Boys Program Grades 5–8 🏀 Girls Program Grades 5–8

Select Grade Level (2026–27 School Year)

5thGrade 6thGrade 7thGrade 8thGrade

Registration Type

New Player$300 Returning Player$250

2 Player Information

Player First Name *

Player Last Name *

Date of Birth *

Grade (2026–27) *

Current School

Jersey Size *

Jersey Number — 1st Choice *

Jersey Number — 2nd Choice *

Jersey Number — 3rd Choice

Position Preference (optional)

Prior Basketball Experience (optional)

3 Parent / Guardian Information

Parent / Guardian Name *

Relationship to Player *

Primary Phone *

Secondary Phone

Email Address *

Home Address *

4 Emergency Contact

Emergency Contact Name *

Relationship *

Emergency Phone *

Alternate Phone

5 Medical Information

Medical conditions, allergies, or physical limitations coaches should know about

6 Waiver & Agreements

Please read each section carefully. A parent or legal guardian must acknowledge every item below in order to complete registration. These agreements are required for participation in the Harvard Jr. Hornets Basketball program.

🛡️1. Assumption of Risk & Release of Liability

I understand that basketball is a physical, contact sport that involves inherent risks — including but not limited to sprains, fractures, collisions, falls, concussion and other head injuries, and in rare cases catastrophic or life-threatening injury. I understand these risks cannot be eliminated regardless of the care taken to avoid them.

Knowing these risks, I voluntarily choose for my child to participate in all Harvard Jr. Hornets Basketball activities, including practices, games, tryouts, tournaments, training, and travel. I accept and assume responsibility for these risks on behalf of my child and myself.

To the fullest extent permitted by Illinois law, I release, waive, and agree not to sue the Harvard Jr. Hornets Basketball program, its coaches, volunteers, directors, and organizers for any injury, loss, or damage arising from my child's participation, except for injury caused by willful or wanton misconduct. I understand I am giving up substantial legal rights by agreeing to this.

I have read and agree to the Assumption of Risk & Release of Liability above.

➕2. Medical Treatment Authorization

In the event of an injury or medical emergency, I authorize the coaches, volunteers, and organizers of the Harvard Jr. Hornets to seek and obtain emergency medical care for my child if I cannot be reached immediately. This may include first aid, and if necessary, transport to a hospital or medical facility by emergency personnel.

I understand that every reasonable effort will be made to contact me or the emergency contact listed on this form before treatment, and that I am responsible for any medical costs incurred on my child's behalf.

I authorize emergency medical treatment for my child as described above.

🧠3. Concussion Awareness & Protocol Acknowledgment

I understand that a concussion is a brain injury that can result from a blow to the head or body, and that concussions can be serious. I understand the Harvard Jr. Hornets follows a "when in doubt, sit them out" approach: any player suspected of sustaining a concussion will be removed from play immediately.

I understand that a player removed for a suspected concussion may not return to play until cleared in writing by a licensed healthcare provider, consistent with Illinois youth sports concussion guidelines. I agree to support this protocol and to inform coaches of any concussion history or symptoms.

I have read and understand the concussion awareness information and agree to the return-to-play protocol.

📸4. Photo & Video Release

From time to time the Harvard Jr. Hornets may take photographs or video of players during program activities for use in team communications, social media, the program website, and promotional materials. No player's full name will be published alongside an image without separate permission.

Please choose one:

I grant permission to use my child's image I do not grant permission

Parent / Guardian Signature

Full Legal Name of Parent / Guardian *

Date *

Relationship to Player *

By typing my name above, I certify that I am the parent or legal guardian of the player named in this registration, that I have read and understand all four sections of this waiver, and that I am signing it voluntarily. I understand that typing my name serves as my legal electronic signature.

7 Payment

Choose your payment schedule

Pay in Full $300

One payment today. Nothing further owed.

3-Payment Plan

Split into three installments across the season.

Payment 1 — At Registration$100

Payment 2 — Mid-Season$100

Payment 3 — Before First Game$100

Payment method

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Card

Credit / Debit

🏦

Bank Account

ACH transfer

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Pay In Person

Cash / Check

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Your card information is protected

Card details are encrypted in transit and processed by a certified payment provider. The Harvard Jr. Hornets never see, handle, or store your full card number.

Name on Card *

Card Number *

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Encrypted as you type

Expiry *

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CVC *

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3–4 digit code on the back of your card

ZIP *

🔒 256-bit encryption ✓ PCI-DSS compliant processor 🛡️ Numbers never stored by the program

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Your bank information is protected

Bank details are encrypted and processed by a certified provider using secure ACH transfer. The Harvard Jr. Hornets never see or store your full account number.

Account Holder Name *

Routing Number *

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9-digit number on the bottom-left of your check

Account Number *

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Account Type *

Bank Name

🔒 256-bit encryption ✓ Secure ACH transfer 🛡️ Account never stored by the program

🧾 Bring cash or a check to the first practice. Your player's spot is held for 7 days — please complete payment promptly to secure it.

🔁

Turn on Auto-Pay

We'll charge each installment automatically on its due date

No due dates to track — each payment runs itself
You'll get an email reminder 3 days before every charge
Cancel or update your card anytime from your confirmation email

✓ Auto-Pay is on. Payments 2 and 3 will process automatically on their due dates.

🔒 Payments are encrypted and processed securely. The Harvard Jr. Hornets never see or store your full card or bank number.

Registration Summary

ProgramBoys · 5th Grade

Player TypeNew Player

Season Fee$300.00

Payment SchedulePay in Full

Due Today$300.00

Season Total$300.00

I have read the Harvard Jr. Hornets Program Philosophy and agree to the player and parent expectations. I understand fees cover uniforms, gym time, and game/tournament fees, and are non-refundable once the season begins.

⚠️ This is a demonstration form. No real payment is processed and no card or bank information is stored or transmitted.

Registration Summary

Registration Received!