LHHS Basketball Program

LHSS Basketball Program Form

Player Information

Player’s Name

Grade

Phone/Mobile:

Parent Information

Parent/Guardian Name

Parent/Guardian Phone:

Parent/Guardian Email:

Team Selection:

Varsity:

Option 1: $850

Option 2: $425

JV:

Option 1: $500

Option 2: $250

Freshman/9th:

Option 1: $500

Option 2: $250

Media Waiver:

Media Release Agreement

I hereby grant permission to [Langston Hughes and PFCPBC] and its representatives to take photographs, video recordings, or digital images of my child in connection with participation in the school’s basketball program. I authorize the school to use, reproduce, and publish these materials in print, broadcast, or online media—including, but not limited to, the school website, social media accounts, newsletters, and promotional materials—without compensation.

I understand that:

All images and recordings become the property of [Langston Hughes].
The student’s full name may be used to identify the individual in connection with the media, unless otherwise indicated below.
I may withdraw this consent at any time by providing written notice to the school’s athletic department.

Consent Options

I give full permission for my child’s image, likeness, and/or name to be used for media and promotional purposes.

I give permission for my child’s image and likeness to be used, but not their name.

I do not give permission for any media use of my child.

Signature*

I authorize PFCPBC to debit my account for the LHHS basketball fees. I understand that this payment will be processed as an electronic funds transfer or draft from my account.

Payment Amount

Transaction Fees

No payment items has been selected yet

Pay with Card (Stripe)

2026-2027 Boys Basketball Registration and Payment

Player Information

Parent Information

Media Waiver: