Freedom Hoops Program Enrollment Application

Program Enrollment Application

Fill out the form carefully for registration to participate in Spring/Summer 2022 Freedom Hoops team activities.
Student Name *

First Name Last Name
Birth Date *

Month Day Year
Gender *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student E-mail *
example@example.com
Mobile Number
Student's School *
Student Grade *
Student Shirt Size

YL S M L XL 2XL
Race (Optional)

Caucasian African-American Asian Hispanic Other
Lives With *

Both Parents Mother Father Grandparent Other
Primary Parent/Guardian
Name *

First Name Last Name
Relationship to Student *
Parent Phone Number *
Work Number
Email
example@example.com
Secondary Parent/Guardian (not required)
Name

First Name Last Name
Relationship to Student
Phone Number
Please enter a valid phone number.
Email
example@example.com
Emergency Contacts (other than parent/guardian)
Name *

First Name Last Name
Phone Number *
Please enter a valid phone number.
Relationship to Child *
Person(s) Authorized To Pick Up My Child (besides parent, guardian, emergency contact)
Name

First Name Last Name
Name

First Name Last Name
Kid Code (secret word for identification and pickup)
Persons NOT Authorized To Pick Up My Child
Name

First Name Last Name
Additional Comments
Student Drivers
Will you allow your child to be transported by another minor? *

YES NO
Comments
Consent to Emergency First Aid & Transportation
I hereby give permission that my child(ren) may be given emergency treatment by a staff member at Freedom Hoops. I also give permission for my child to be transported by car, ambulance, or Aid car to an emergency center for treatment, and agree to hold Freedom Hoops and their employees/volunteers harmless.
Signature *

Clear
Consent to Medical Care & Treatment
In the event that I cannot be contacted immediately, medical of surgical treatment can be administered to my child in the case of an accident or emergency, as prescribed by a treating physician, and hold Freedom Hoops and their employees/volunteers harmless.
Signature *

Clear
Medical Information
Food allergies
Any special health conditions
Field Trip Permission
I hereby request that my child(ren) to be permitted to participate in field trips, outings to the park, or any other activities that would involve taking the child outside of the after school center for his/her cultural, social and educational benefit in attendance at this facility. I also understand that if there will be a fee for said trip I will be notified of said fee and fee payment due date before said trip. *

YES NO
Media & Social Media Policy
I/we give Freedom Hoops permission to post pictures/video of my son to various media outlets. *

YES NO
Suspected Child Abuse or Maltreatment Allegation Disclosure:
This is to inform you that if a Freedom Hoops staff member suspects abuse or maltreatment to one of the children in the program, a report will be made. Interviews may be performed by the State Police and/or a Child Care Licensing Specialist from the Department of Human Services (DHS).
Signature *

Clear
Freedom Hoops Covenant

Young men joining Freedom Hoops agree to the following:
1. Effort
1. Practices/Events: Show up on time, be respectful to all people, and get after it.
2. Come enthusiastically to practice and get better.
3. 10 minutes before the event, shoes tied, clothes on, hydrated, and mentally prepared for max effort.
2. Team Behavior: We are always together as a team representing our core values. (Practice, travel, eat, donors, KAA, etc.).
1. Inappropriate language (“N” word, swear words, etc.) will result in consequences set forth by coaches.
2. Meals
  1. Take a picture with the group smiling
  2. Take a picture of your food if you want
  3. Put the phone away. If we continue to remind, we may take your phone away.
  4. Put away phones during meals, team time, games, campus visits and other activities where the team is officially together.
3. Communication
1. Instagram Chat:
  1. Quick Communication: Please communicate quickly with coaches, whether or not you know the answer.
  2. Texting Etiquette: State your problem or question in the 1st text. No: “Aye”, “Coach”, “Hey” texts.
  3. Communication for rides must be sent the day before the event.
4. Basketball
1. Coaches have full discretion over playing time. Conversations about playing time are with coach D’Vante.
2. Disrespect toward coaches, referees and tournament staff will result in disciplinary action by coaches.
3. Technical fouls will result in missing a game.
4. Fighting results in missing a tournament up to removal from the team.
5. When out of the game, I will remain engaged and cheer on my team.
Quitting during a contest will result in missing a game up to removal from the team.

5. Fees:
1. $50 Team Fee: Helps cover travel and gear
2. $25 KAA Fee: We are going to summer camp June 5-11. We need to know by Friday March 25th if you can go.
6. Fundraising Events: Sporting KC, Fireworks stand, & other opportunities.

7. Cleanliness: Practice, meals, games, van, hotel, and wherever else we go I will clean after myself and my team when we leave a place.

8. We are a faith-based organization, and if this makes you uncomfortable then please talk to us separately. We aren’t demanding anyone follow Jesus, but we would love for you to engage respectfully in our conversations.

As Coaches we will offer the following:
1. Credible and Caring: Trained and background-checked coaches who will care for your son more than basketball
2. Funding: Fully-funded program except for the fees and occasional meal or snacks on the road
3. College Exposure: Four NCAA live events, highlight video of your son, & communicate with college coaches
4. Faith: Encouragement to follow Jesus
5. Humble and repentant hearts
Signature

Clear
Parent Pledge
I will use positive encouragement to emotionally support my children, their teammates, and coaches. I will:
- Encourage my child to give maximum Effort
- Help my child Learn through sports
- Urge my child to get past Mistakes by focusing on the next play and moving forward
I will set an example for my child by Honoring the Game, and the Rules, Opponents, Officials, and Teammates

If I disagree with a coach's decision, I will honor and be respectful to the coach and find a time to communicate with that coach.

If I disagree with an official’s call, I will Honor the Game and be respectful to the referee.

I will refrain from negative comments about my child’s coach in my child’s presence so that I do not negatively influence my child’s motivation and overall experience.

I will be as prompt as possible dropping my child off and picking my child up from practices and games.

I will limit my comments during the game to encouraging my child and other players (from both teams). I will honor a coaches request to quiet down or

If I have a complaint towards my son’s coach, I will respectfully ask for a meeting after 8 hours or a night of sleep has passed. This allows all parties to speak rather than vent emotionally. At the conference I agree to talk about the following:
- My son’s effort, attitude, effort and skill development
- We will not talk about other players' weaknesses, etc.
- We will not talk about coaching strategy, etc.
In the event that I can’t be accountable to this pledge, I acknowledge that this could mean removal from games, practices, or removal from the team.
Signature

Clear
Participation Agreement, Release and Acknowledgement of Risk
In consideration of the services of Freedom Hoops, its agents, owners, officers, volunteers, participants, employees, and all other persons or entities acting in any capacity on their behalf, I hereby agree to release and discharge Freedom Hoops, on behalf of myself and my children, parents, heirs, assigns, personal representative and estate as follows:

1. I acknowledge that my participation in the Freedom Hoops Program entails known and unanticipated risks which could result in physical injury or damage to myself, to property or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.

2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

3. I hereby voluntarily release, forever discharge and agree to indemnify and hold harmless Freedom Hoops from any and all claims, demands or causes of action, which are in any way connected with my participation in this activity or my use of Freedom Hoops equipment or facilities, including any such claims, which allege negligent acts or omissions of Freedom Hoops.

4. Should Freedom Hoops or anyone acting on their behalf be required to incur attorney’s fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for such fees and costs.

5. I certify that I have health, accident and liability insurance to cover any bodily injury or property damage I may suffer while participating in this event, or else I agree to bear the costs of such injury or damage myself.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Freedom Hoops on the basis of any claim from which I release them herein.

I have had sufficient opportunity to read this entire document. I have read and understood, and I agree to be bound by these terms.
Signature *

Clear
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Program Enrollment Application

Primary Parent/Guardian

Secondary Parent/Guardian (not required)

Emergency Contacts (other than parent/guardian)

Person(s) Authorized To Pick Up My Child (besides parent, guardian, emergency contact)

Persons NOT Authorized To Pick Up My Child

Student Drivers

Consent to Emergency First Aid & Transportation

Consent to Medical Care & Treatment

Medical Information

Field Trip Permission

Media & Social Media Policy

Suspected Child Abuse or Maltreatment Allegation Disclosure:

Freedom Hoops Covenant

Parent Pledge

Participation Agreement, Release and Acknowledgement of Risk