SCS Basketball Academy Class Schedule

SCS Academy Basketball Registration

(5 and up)

Girls & Boys

*Locations

Titusville: 701 South St, Titusville, FL 32780

Viera: 5225 Tavistock Dr. Rockledge, FL 32955

Melbourne: 3410 Flanagan Ave
West Melbourne, FL 32904
* You may choose more than one location, but it will go towards your 6 sessions.

Athlete Information

Player Name *

First Name Last Name

Player Name

First Name Last Name

Player Name

First Name Last Name

Age: *

Age:

Gender: (Mark Checkbox next to) *

Female Male

This is for INDIVIDUAL TRAINING ONLY IN SMALL GROUPS. We will specialize on more one on one skills training according to your player needs. There will be an evaluation of skill set and we will make the adjustments needed to improve in that area.

*choose ONE

Date Reservation

Time

: Hour Minutes AM/PM Option

Shirt Size (check all that apply) *

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult X-Large

Medical Information:

Does you have any allergies, chronic illness, or medical conditions that would limit high level activtiy? *

Yes No

Parent/Guardian Information:

Parent/Guardian: *

First Name Last Name

Phone *

Area Code Phone Number

E-mail: *

Emergency Contact

Emergency Contact's Name: *

First Name Last Name

Phone Number: *

Confirmation

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by SCS Academy and SCS Athletes during the selected camp. In exchange for the acceptance of said child’s candidacy by SCS Academy., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless SCS Academy and Athletes . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against SCS Academy and Athletes . including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

I give SCS Academy permission to use my child's photos and videos for website and promotional purposes.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature

Clear

After completing this form, please click Submit Form. You will receive a confirmation email. If you do not receive the email within a few minutes, please check your spam; otherwise, please contact us at hondoathletics@gmail.com

SCS Academy Registration *

6 weeks $ 125.00

Shirt, Jersey, Orlando Magic Ticket Included

Number of Participants

Enter coupon

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00

Referred by

Name of who referred you