Game Speed Hoops

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Basketball Camp Registration Form

GAME SPEED HOOPS BASKETBALL CAMP

* Choose Event:

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

* Birthdate:

Email:

Gender:

Grade as of the 2018-2019 School Year:

PARENT/GUARDIAN #1

* First Name:

* Last Name:

* EMail:

* Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

Medical Conditions - Please list below any medical conditions and/or allergies that you think we should know about::

WAIVER INFORMATION

I hereby waive, release and discharge any and all claims for damages for the personal injury, death, or property damage which I may have, or which hereafter accrue to me or my child, as a result of participation in basketball practices and/or basketball competitions in all its forms. The release is intended to discharge in advance, the organization (Game Speed Hoops), it’s coaches or volunteers from any and all liability arising out of or in any way connected with my participation in said activity. Its understood that the activity involves an element of risk and danger of accidents and knowing those risks, I assume those risks. It is further agreed that this waiver, release, and assumption of risk, is to be binding on my heirs and assigns. I agree to indemnify and to hold the Game Speed Hoops, all persons and entities associated with the (Game Speed Hoops), free and harmless from any loss, liability, damage, cost or expense, in which they may incur as a result of death, injury or property of damage that I may sustain while participating. I also give Game Speed Hoops, it’s coaches or volunteers the right to copyright and/or publish, reproduce, or otherwise use my child’s name, voice, and likeness and/or photographs, and audiovisual recordings that include my child for instruction, advertising, program website, publications or brochures, or any other lawful purpose whatsoever. I hereby agree to relinquish all rights, title and interest I may have in the finished product and waive all rights to any compensation thereof.

I/we agree with the above *

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Basketball Camp Registration Form