PSA Registration Waiver Form

PSA Registration Waiver Form
Paxton Sports Academy-PSA Vikings
Website: www.paxtonsportsacademy.org
Email: paxtonpsacademy@yahoo.com
2773 Illinois Street
East Palo Alto, CA 94303
Childs Name*

First NameLast Name
Parent/Guardian*

First NameLast Name
Address*

Street Address

Street Address +

CityState / Province

Postal / Zip Code
Home Number
Cell Number*
Work Number
Email*
example@example.com
Spring-Summer Local & Travel Basketball, Ages 7-18: (Jan-Aug): Cost $350

yesno
Fall-Winter Travel Basketball, Ages 7-18 (Sept-Dec): Cost: $250

yesno
Uniform Cost $150:

yesno

Uniform Orders

	Small	Medium	Large	X Large	XX Large	XXX Large
Uniform Jersey Size (Adult)
Uniform Shorts Size (Adult)
Uniform Jersey Size (Youth)
Uniform Shorts Size (Youth)

Child Birth Date*

MonthDayYear
Height*
School Name*
Weight*
Age*
Grade*
Do you wish to become a volunteer? If so, please check your area(s) of interest below: General Assistance

FundraisingTutoringCoachingRegistration/EnrollmentTeam RefreshmentsTravel Arrangements
PHOTO RELEASE FORM
I hereby grant Paxton Sports Academy, its representatives and employees, or anyone authorized by Paxton Sports Academy, permission to use my likeness and/or the likeness of my child(ren) in a photograph in any and all illustrations, advertising, publications, including website entries, without payment or any other consideration. I understand and agree that these materials, including all negatives and positives, together with the prints, will become the property of Paxton Sports Academy and will not be returned. I hereby irrevocably authorize Paxton Sports Academy, its representatives and employees, or anyone authorized by Paxton Sports Academy, to edit, alter, copy, exhibit, publish or distribute this photograph for the purposes of publicizing Paxton Sports Academy programs or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness or the likeness of my child(ren) appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.
Parent/Guardian*

First NameLast Name
Child First Last name*

First NameLast Name
Signature*
Date*

MonthDayYear
Date

Paxton Sports Academy Basketball Waiver Form

*Waiver must be completed and turned in prior to your child/children’s participation (one child per form)*
INSURANCE WAIVER

I fully understand that Paxton Sports Academy does not provide health or life insurance coverage for the above named child while he/she is participating in any of Paxton Sports Academy training programs. I/We further understand that it is my/our responsibility to provide adequate insurance coverage to the above named child.
Emergency Information: If we cannot contact listed parents or guardians, call:
Child Medical Information: If we cannot contact listed parents or guardians, call:
Guardian's Name*

First NameLast Name
Guardian's Signature*
Date*

MonthDayYear
Date
OFFICIAL USE ONLY - Paxton Sports Academy Representative, Title (printed)

First NameLast Name
OFFICIAL USE ONLY - Paxton Sports Academy Representative, Signature

PSA Vikings Fall Ball Season
What is Fall Ball Season and/or Fall-Winter Basketball Clinics?

This is the time where travel basketball season slows down. PSA uses the time too primarily concentrate on building up individual player’s specific skill sets.
What are the requirements to participate in Fall Ball Season?

The Fall Ball Season and/or Fall-Winter Basketball Clinics is commitment to attend at least 2 practice development session days per week when schedule is shared with participants. The competition Fall Ball season September through mid December. The end depends upon the participation level of the
families and could extend through in the next calendar year.

Fall Ball Season requires the commitment to participate in at least one tournament per month. There will be 1-2 tournament events scheduled each month. All tournaments will be in the local bay area only.

All required fees must be paid in full on or before October 1 in current year.

There may be times in the Fall Ball Season to meet financial costs of tournament entry fee, each player can be responsible for contributing to a specific cost per tournament deemed appropriate by coach. This is typically anywhere from $20-25 per player depending on the tournament entry cost and
number of players on the team.

New PSA Registration and Waiver Forms for Spring-Summer, Fall Ball Season and/or Fall-Winter Basketball Clinics must be complete and submitted no later than August 31 in current year. All participants must identify which basketball program(s) Spring-Summer, Fall Ball Season and/or Fall-Winter Basketball Clinics interested to join.

Player birth certificate must be submitted with completed registration and waiver forms.

What are the primary goals of Fall Ball Season and/or Fall-Winter Basketball Clinics:

Participate effectively in their school’s (6-12 grades) basketball program.

Obtain more defined skill sets during the Fall Ball Season. Grow and develop to compete at an elite/advanced/intermediate level during travel season. Develop a higher basketball awareness IQ, which helps make better decisions on and off the court. Each player will receive consistent evaluation and feedback by the coach on things to work on in and outside of practice.
PSA Vikings (In order to make registration easier payment can be made after registration, please remove checks to submit if payment will come later)
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Uniform Cost
$150.00



Spring/Summer Local & Travel Basketball
$350.00



Fall/Winter Local & Travel Basketball
$250.00



Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

PSA Registration Waiver Form

PHOTO RELEASE FORM

Paxton Sports Academy Basketball Waiver Form

PSA Vikings Fall Ball Season