IMAGO DEI MINISTRIES

"One Family, One Vision, One Accord"

Home
IDM Family
Mentoring Programs
Panthers Basketball
Annual Benefit
Online Store

Home
IDM Family
Mentoring Programs
Panthers Basketball
Annual Benefit
Online Store

Team Registration Packet

Player's Full Name*

Date of Birth *

Age*

Height*

Position(s) You Play *

Point GuardShooting GuardSmall ForwardPower ForwardCenter

Name of School*

Grade In School *

Player's Phone *

Player's Email Address

Parent/Guardian's Name*

Parent/Guardian's Phone*

Parent/Guardian's Email Address

Address*

City, State, Zip*

I hereby give permission for my child to participate in the Imago Dei Ministries, Inc., Panthers Basketball Program, in Chicago and any other place where training is held in which they are a participant, while participating with the Panthers Basketball I understand that this program includes running, jumping, throwing and other skills. There is an inherent risk in basketball. Injuries include but are not limited to sprained ankles, muscle pulls, and injury to joints, bones, ligaments& tendons, neck & back injuries, and even death. In an effort to make the program run more safely, it is vital that all athletes follow instructions given. *

______________________________________________________________________ Parental Consent

AgreeDisagree

I grant permission for the administration to render first aid to my child by the people in charge of the Imago Dei Ministries, Inc. Panthers Basketball Program and those transporting my child to and from the program as their judgment deems advisable and to make the necessary referrals to qualified physicians for treatment of illnesses or accidents of a more serious nature. I understand that I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. In case of medical emergency, I understand that every effort will be made to contact the parent/guardian of the participant in the event I cannot be reached, I hereby give permission to the physician selected by the adult staff to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery, if deemed necessary for my child. *

_________________________________________________________________________ Parental Consent

AgreeDisagree

I consent to the use of my name, voice, likeness, picture, quotation, comment, testimonial, and/or tips (individually or collectively, the “Submissions”) by IDM Panthers Basketball, its parent company, and their subsidiaries, related or affiliated companies (“collectively, “Company”), for advertising, trade, and any other lawful purpose, together with the right to copyright and publish the same and/or permit registration as a trademark or service mark with respect to any materials incorporating the Submissions.*

_________________________________________________________________________ Parental Consent

AgreeDisagree

I also grant Company a non-exclusive, irrevocable, worldwide, royalty-free license to reproduce, distribute, and publicly display the Submissions (including, but not limited to, my photograph, as well as my first name, last initial, home state), in promotions and other publications in any and all media, in any locale, in perpetuity, for any purpose whatsoever, without any compensation, provided it is understood that Company shall not utilize my submission in any way to intentionally and maliciously subject me to conspicuous ridicule or indignity. I grant Company the right to edit my Submissions.*

_________________________________________________________________________ Parental Consent

AgreeDisagree

I hereby release and indemnify Imago Dei Ministries, Inc., its staff, its volunteers, and the gym location that is used as the host site, from any and all liability arising from claims of any kind or nature whatsoever from my child's participation in this program.*

_________________________________________________________________________ Parental Consent

AgreeDisagree

Please list all known medical conditions that could be impacted while playing basketball*

Authorized Physician's Name

Physician's Phone

Insurance Company

Policy Number

In the case of an emergency the staff of Imago Dei Ministries, Inc. should contact:

This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Thank you! Your information was sent successfully. There will be a MANDATORY player and parent orientation via Zoom on Sunday, April 11, 2021 at 3:00 p.m. The Zoom notification will be sent to the information provided when you complete the registration packet.

Panther Program Information

Team Name: IDM Panthers Established: 2009 Colors: Black & Gold

Age Groups: 14U (7th & 8th Grade), 16U Freshman & Sophomores),

17U (Varsity)

Staff: Mario Jackson - Program Director & 16U Coach

Chematae Guy - Assistant 16U Coach

Burton Anderson - 17U Coach

Victor Junious - 14U Coach

Shannon Carroll - Manager

Season: April - July (There will be no practices in June if the IHSA approves summer league competition for high school players)

Team Roster: 10 - 12 players per roster

Eligibility: Players cannot be committed to any other AAU/Travel teams

Practice Facilities:

Blue Island Rec, 2805 141st St, Blue Island, IL 60406

Calumet Park Rec, 12426 S Loomis St, Calumet Park, IL 60827

Robbins Community Center, 13800 S Trumbull Ave, Robbins, IL 60472

Program Fees: $300 (Due to having a condensed season all fees have been reduced. Fees will cover tournament costs, insurance, equipment, uniform maintenance, travel expenses, etc.)

Deadline: All fees should be paid by April 30, 2021

Communication: Our website is the BEST way to stay connected and informed. You are encouraged to check it weekly. The schedule for the season including practices and games will be posted on the site and will be updated weekly as things change. Each coach’s phone number will be listed on the bottom of the schedules. If you have concerns that are not answered on the site please contact your Head Coach. If your Head Coach is unavailable or if more assistance is required then contact the Program Director, Mario Jackson.

Forms of Payment:

Cash

Money Order Payable: Imago Dei Ministries

Zelle: [email protected]

PayPal

Program Fees

Name of Player

Office: 11705 S. Elizabeth, Chicago, IL 60643

(Seeds Center Building)

Mailing: P.O. Box 439328 - Chicago, IL 60643

Phone: 800-362-7925

Fax: 877-459-7066

Email: [email protected]