Spring Training Session

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

PUSH — Preparation Until Success Happens!

Player Information

Under 12 Eligibility – A player must not have reached the age of 12 prior to Jan. 1st, 2023.

Under 14 Eligibility – A player must not have reached the age of 14 prior to Jan. 1st, 2023.

Under 16 Eligibility – A player must not have reached the age of 16 prior to Jan. 1st, 2023.

Under 18 Eligibility – A player must not have reached the age of 18 prior to Jan. 1st, 2023.

PUSH Alumni. Have you participated in any PUSH Training Sessions? *

Yes

DIVISION *

Player Name *

Date of Birth *

YYYY

Parent/Guardian Information

Name *

Phone Number *

Street Address *

City *

Postal Code *

Player Medical Conditions

Awareness of special requirements helps us better serve everyone

Health Card Number

Emergency Contact(if different than parent or guardian above)

Name

Relationship to player

Phone Number

Authorizations and Release

Photograph Permission

I give permission for the PUSH Cape Breton basketball program to use any pictures of my child for future promotional purposes.

Medical Treatment

I hereby give permission for my child to be given cardiopulmonary resuscitation (CPR) and first aid treatment by a qualified staff member in the event I cannot be contacted. I also give permission for my child to be transported by ambulance to an emergency center for treatment. I further consent to the disclosure of health information and to the medical, surgical, and hospital care treatment and procedures (including, but not limited to, administration of necessary anesthetics, tests, x-ray examinations, transfusions, injections, and drugs) to be performed for my child by a licensed physician or hospital selected by the PUSH Basketball Program when deemed immediately necessary or advisable by the physician to safeguard my child’s health.

Release from Liability

Recognizing the PUSH Basketball program will do its best to ensure a safe experience, I understand that accidents may occur both from my child’s participation in youth sports activities and from transportation to and from the program. I agree to assume these risks. By signing below, I release the PUSH Basketball program and its agents from all liability based on any damage, loss or injury whether it is the result of ordinary negligence or otherwise, caused to my child or to me, from participation in the youth sports program.

I have read and understand the above and have completed this form to the best of my ability.
*

I Understand and Agree

Required

Name of parent or legal guardian
*

PUSH Volunteer Coaching

Would you like to be a volunteer coach?
*

Yes

Nation Coaching Certification Program (NCCP)#

All coaches are required to have an updated child abuse registry check. It can be now completed online.

https://beta.novascotia.ca/apply-child-abuse-register-search

All coaches are required to have an updated criminal record check. It can be now completed online. The Organization is Basketball Nova Scotia

https://www.mybackcheck.com/Public/Login.aspx