• This form must be completed in its entirety. 

• All 4 Sections must be complete or registration may be rejected.  

• Registration is not complete until you click Submit at the bottom of this page and pay the appropriate registration amount.

Section 1.

Player Information

  Please provide the following regarding the player:

First Name
Last Name
Street Address
Address (cont.)
City
State
Zip/Postal Code
Cell Phone Number
Home Phone Number
E-mail

Name of School
Year of High School Graduation	Please select one: 2009 2010 2011 2012 2013
GPA
Height	Please select one: 5 1 5 2 5 3 5 4 5 5 5 6 5 7 5 8 5 9 5 10 5 11 6 0 6 1 6 2 6 3 6 4 6 5 6 6 6 7 6 8 6 9 6 10 7 0 7 1 7 2
Weight

Have you participated in IEBP’s Fall Showcase in prior years?  If so, when?

Do you currently play for a Club/Travel Basketball Team? If yes, what team?

On what level do you anticipate playing basketball during 2008/09?

  Please select one: Varsity Junior Varsity Freshman Middle School/Junior High Did not play in 2005/06

Gender:

  Male Female Select One

Section 2.

Parent's Information

Please provide the following regarding parent(s).  You may indicate n/a if only entering parental information for one parent:

Father's First Name
Father's Last Name
Mother's First Name
Mother's Last name
Home Phone
Cell Phone
E-mail

Section 3.

Fall Showcase 2008 Release

The following is to be read and completed by a parent or guardian of the player named below.  Registration will be considered incomplete and players will not be allowed to participate if this section of the registration is not complete.

 I, the undersigned guardian/parent of (enter child’s name),     freely give consent for my child to participate in the 11h Annual Fall Classic Showcase sponsored by the Inland Empire Basketball Program (IEBP).  I understand that the above mentioned entities retain the rights to use photographs or statistical information of participants. 

 I agree to hold harmless, release, and disclaim any form of liability against Inland Empire Superstar Foundation, Inland Empire Basketball Program, coaches, adidas, and other corporate donors from indemnification for any accidents and/or injuries that my child sustains while the child participates, in route to or from participation, in or activities connected to, the Fall Classic Showcase.  The privacy of this disclaimer shall not be given or delegated to any person or personnel of any entity, except Inland Empire Basketball Program, without the written permission from the parent, unless a medical, contractual or legal duty arises.

 I give the representative(s) of Inland Empire Basketball Program, Inland Empire Superstar Foundation the authority and permission to allow medical providers to provide necessary medical attention to my injured child when the injury occurs in the 11th Annual Fall Showcase.

Medical Insurance Co 

Policy#   

 Physician's Name: 

Telephone Number:

 Parent/Guardian Name:              

 Date:10/20/2008

By typing your name in this box, you are signing and agreeing to the release as printed.  Parent/Guardian Signature:

 

Section 4.

Fall Classic Showcase Registration is $50.00

Please note the following:

1. You must visit PayPal to pay your registration, or mail to Inland Empire Basketball Program.  Payment must be received by October 24, 2008.

You may pay your registration online or you may complete this registration form, click the Submit Button below and mail the appropriate amount to:

    Inland Empire Basketball Program (IEBP)

    3410 La Sierra Avenue

     Box # F-213

     Riverside, CA 92503

 

Please indicate method of payment:

  Please select one: Online payment Will Pay by Money Order On-Site on Saturday Other

 

Please e-mail any questions or issues to iebp@aol.com.  Staff will respond within 24 hours.

 

You may print your registration form for your records prior to submission.

After successful submission, you will be directed to the PayPal website to make your payment.

 

Please do not complete the registration form multiple times.   If you are unsure as to whether your registration was received successfully after your first attempt or if you need to make corrections after submission, please e-mail iebp@aol.com.

Thank you for registering for the 2008 Fall Classic Showcase!!  We look forward to seeing you in on November 1st!