Dreamcatchers Athletic Performance (DAP)

Individual Registration Form

Choose a package

Basketball TraininBasketball Training & Intro to Horseback Riding

Participant's Name*

First NameLast Name

Birth Date*

MonthDayYear

Gender*

MaleFemale

Grade*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent/Guardian Information

Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Alt. Number

Area CodePhone Number

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Parental Release & Refund Policy --- Please Read Carefully I hereby give approval for the participation of my child in any and all Play With Purpos/DAP activities and assume all risks, hazards and incidents to such participation, including transportation to and from all activities. I waive, release, absolve, indemnify and agree to hold harmless the DAP, affiliated associations, organizers, officers, coaches, parents, participants and officials from any claim arising out of injury to my child. I hereby give permission for DAP to obtain medical services for my child in case of medical emergency or injury. Refunds requested before the program starts will be honored with a $25 processing fee deducted. No refunds will be issued due to inability or unwillingness to attend/participate. Prorated refunds will only be considered for players when a medical/physical injury/illness, verified by a physician's written statement, precludes participation or attendance in class/practice. I/We understand that NO REFUNDS will be issued other than stated above. I declare that my child or I are physically fit and have the skill level required to participate in this particular event. I also understand that my child or I may be required to leave the facility should my child or I exhibit undesirable conduct. I further grant released parties the right to photograph and/or video tape me or my child and further to use my or my child's name, face, likeness, voice and appearance in connection with exhibitions, publicity, advertising and promotional materials without reservation or limitation. The released parties are, however, under no obligation to exercise said rights herein granted.

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*

Date*

Dreamcatchers Athletic Performance Registration