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Welcome to the County Clippers Rep Basketball Registration Page

Tryouts will be held on September 15th, 17th & 19th @ PECI for players interested in playing rep who are born in the following years.
CO-ED 2017 & 2016
Boys born in 2009- 2015
Girls born 2012 - 2015

You must register prior to attending tryouts

County Clippers Basketball Health Waiver & Release Form

You will not be admitted to the tryouts without this form completed. Email info@countyclippers.ca with any questions.

Athletes First name*

Athletes Last name*

Gender*

Male

Female

Height*

Weight*

Birthday*

Year

Month

Day

Athletes Email

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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