School Holiday Enrollment
Only complete this form for School Holiday Programs
Player's Full Name
*
First Name
Last Name
Gender
*
Male
Female
Age
Any Specific Medical Conditions Requiring Attention?
*
Yes
No
If Yes, Please Provide Details
Parent/Guardian's Full Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Risk Indemnity and Waiver
*
You agree and undertake to pay costs which may be incurred for medical attention, ambulance transport and medication while you or your child is participating in our holiday program
You understand that although our staff and service providers attempt to minimize any risk of personal injury within practical boundaries, accidents do happen and all physical activities carry the risk of personal injury
You acknowledge that there is an an inherit risk of personal injury in physical activities that will be undertaken at our holiday program and you accept the risk
Media Release and Consent
*
I authorize and grant Hoops Connect to take my child's photos
I grant Hoops Connect to use my child's photos on Facebook, Instagram and other social media platforms
I allow Hoops Connect to edit, alter, copy and distribute the photos for advertising and marketing
Signature
*
Submit
Should be Empty: