Serving the Youth of the Hudson Valley Since 2010 Untitled Header Image 2nd Annual DCH Youth Sports 5K Run & Kids' Fun Run
 

2022 DCH Saturday Basketball Registration

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2022 DCH SATURDAY BASKETBALL REGISTRATION

Boys & Girls 5-13 yr olds

Cost: $55

sibling discount: First Child: $55 Second: $50 Third: $45 Fourth: Free

Dates: 1/8 - 2/26 [NO MAKE-UP DATES]

Session/Times:

1st Session: Players 5-8 yrs old: 10:00-11:00AM

2nd Session: Players 9-13 yrs old: 11:00-12:15PM

Location: New Beginnings Church Gym 

36 DeGarmo Road, Poughkeepsie 12603

SPACE IS LIMITED

1. *

Please Choose One 

First Session - 10-11:00AM - Players 5-8 yrs old Second Session - 11-12:15PM - Players 9-13yrs old
2. *

Player Name (first/last):

3. *

Date of birth (mm/dd/yyyy):

4. *

Age (as of 1/08/2022):

5. *

Grade:

6. *

Does this player have any current injuries or physical limitations or any medical condition a coach/athletic director should be aware of?

 (1 required)
No Yes
7. *

If yes, please explain:

8. *

Medical Insurance Carrier & Policy Number:

9. *

Physician:

10. *

Physician Telephone Number:

11. *

Parent(s)/Guardian(s) Name:

12. *

Address/City/Zip:

13. *

Cell Phone #:

14. *

Email:

15. *

Best method of contact. Please choose one:

 (1 required)
Cell Text
Email
16. *

Emergency contact person and relationship to player (first/last name):

17. *

Emergency contact person cell number:

Photograph/Video Permission

In consideration of participation in the DCH Sports Saturday Basketball, be advised that your child/ward may be photographed and/or videotaped at a DCH Sporting event. The likeness of your child/ward may be published to the DCH Sports website, Facebook page, and/or Instagram site only to promote or publicize the DCH Sports program.

NOTE: DCH Sports will NOT publish any participant's last name.

18. *

I hereby give DCH Sports permission to publish my child's likeness to one or all of the DCH Sports media as only relating to DCH Sports.

Yes No
19. *

Parent/Guardian Initials (this will serve as your signature):

20. *

DCH SPORTS INC MINOR WAIVOR/RELEASE

Release of Liability for Minor Participants

READ BEFORE SIGNING

IN CONSIDERATION OF MY CHILD/WARD, being allowed to participate in any way in the DCH Sports Inc. related events and activities, the undersigned acknowledges, appreciates, and agrees that:

  1. The risk of injury to my child/ward from the activities involved in this program is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
  2. I FOR MYSELF, SPOUSE, AND CHILD/WARD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsiblity for my child/ward's participation; and,
  3. I willingly agree to comply with the program's state and customary terms and conditions for participation. If I observe an unusual significant concern in my child/ward's readiness for participation and/or in the program itself, I will remove my child/ward from the participation and bring such attention of the nearest official immediately; and,
  4. I for myself, my spouse, my child/ward, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS DCH Sports Inc; its directors, coaches, volunteers, other participants, sponsors, advertisers, and owners and lessors of premises used to conduct the event, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child's/ward's involvement or participation in this program, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
  5. I, for myself, my spouse, my child/ward, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my child's/ward's involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INUCEMENT.

PARENT/GUARDIAN NAME (this will serve as your signature):

21. *

Player T-Shirt Size (choose one from drop down)NOTE: Regretfully, DCH cannot guarantee t-shirt size to registrations received after Monday, December 20.

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Player Fee: $55.00 per child (sibling discount below).

Payments can be made via PayPal, check payable to DCH Sports or cash.

Sibling discounts are as follows: 

First Child = 55.00

Second Child = 50.00

Third Child = 45.00

Fourth (and more) Child = Free

Capped at $150 per family

After submitting registration a PayPal payment option is available.  

We apologize, DCH is experiencing technical difficulties with the PayPal option. PayPal is overcharging and incorrect.

Until corrected, the options to pay are:

  • At first Saturday Basketball families can pay cash or check payable to DCH Sports.
  • Mail to:  DCH Sports, 14 Wright Boulevard Hopewell Junction 12533,
  • Or utilize the PayPal "Donate" button on DCH Sports website homepage. Here a custom amount can be entered. We will match your email to the participant.