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Welcome to the County Clippers Girls Open Gym / Drop In Registration

Registration Fee is $50.00

Session 2 -- Friday October 23, 2026
Session 3 -- Friday November 6, 2026
Session 4 -- Friday November 13, 2026
Session 5 -- Friday December 4, 2026
Session 6 -- Friday December 18, 2026

You MUST register prior to attending the first session.
Fees are payable via e-transfer ONLY. Please send funds to fees@countyclippers.ca

County Clippers Basketball Registration + Health Waiver & Release Form

Registration fee is $50.00

Etransfer are to be sent to fees@countyclippers.ca You MUST include your athletes name in the memo line of your transfer.

Email admin@countyclippers.ca with any questions.

Athletes First name*

Athletes Last name*

Birthday*

Year

Month

Day

Parent / Gurdian First Name*

Parent / Guardian Last Name*

Parent / Guardian Email*

Address*

Phone*

Do you concent to recieve emails containing updates, promotions, newsletters & invitations to programs & events hosted by The County Clippers*

Yes

Do you consent to your childs photo being used on The County Clippers social media & Website?*

Yes

Primary Emergency Contact First & Name *

Primary Emergency Contact Phone Number*

Secondary Emergency Contact First & Name *

Secondary Emergency Contact Phone Number*

Does your athlete have any alergies, limitation, or medical condistions that you would like us to be aware of?*

Has the athlete been exposed to any communicable diseases in the last three weeks*

Yes

Should the athlete be restricted from any activity *

Yes

If your player is covered by the Ontario Health Insurance Plan (OHIP), you acknowledge that OHIP may have limited coverage for certain health services and that you are responsible (e.g. private medical insurance) for any additional costs not covered. *

Yes

Full Legal Name on OHIP Card*

You understand you will be financially responsible for any medical attention your player needs during tryouts or resulting from an injury received at tryouts. You give permission for the named player to receive emergency medical or surgical treatment and *

Yes

Parent / Guardian First & Last Name*

I declare that the info I’ve provided is accurate and complete.

Parent / Guardian Signature *

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