Global Sports & Education - Academy Partners Registration Form

***PLEASE INSERT PROGRAM DATE ACCORDING TO EVENT PROMOTION MATERIAL FOR YOUR SELECTED PROGRAM***

Select Program Location

10 or 14 Days of FUN & Discovery! Florida, USALas Vegas Showcase, Las Vegas, USAHoliday Fest! Cape Town, South AfricaSummer Camp, Toronto, CanadaOther

Code Associated with Registration (Select One)

Select Start Date

MonthDayYear

Select Ending Date

MonthDayYear

School/Academy/Club Information

Institutions Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Name of Principal or Director

First NameLast Name

Participating Manager or Director

First NameLast Name

Manager or Director Cell Number

Area CodePhone Number

Manager or Director E-mail

esempio@esempio.com

Participant Information

Participant Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Name on Passport

First NameLast Name

Passport Details

Passport NumberCountry Issued by

Passport

Issued DateExpiration Date

Athletic Information

Participating Sport

BasketballSoccerOther

Sport Skill Level

Very HighCompete for FunOther

Participant Measurements

HeightWeight

T-Shirt SizePolo Shirt Size

Jersey SizeShorts Size

Parent/Guardian Information

Name

First NameLast Name

Home Number

Area CodePhone Number

Cell Number

Area CodePhone Number

E-mail

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

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

Is the participant /athlete prescribed an inhaler or medication? If yes, please explain any instructions.

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Global Sports & Education - Academy Partners during the selected program. In exchange for the acceptance of said participants candidacy by Global Sports & Education - Academy Partners, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Global Sports & Education - Academy Partners 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 participant, I hereby waive all claims against Global Sports & Education - Academy Partners . 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.

Medical Release and Authorization As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named participant or athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the Global Sports & Education - Academy Partners LLC . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named participant, minor child, in my absence.

AGREEMENT FOR PERSONAL DATA USE. I hereby declare that I have been informed as per common practice of the organizations and programs activities, that all forms of collected data provided and captured during programs and activities shall be used and treated with respect adhering to the United States and international laws governing the safety of minors and human rights under the United States Law and the Communications relative to art. 13-14 of European Union Rules n. 679/2016.

We agreed to allow the use of my personal data, including sensitive information, for the operation affiliation to the Global Sports & Education – Academy Partners and the Heat Entertainment Arts & Technology (Ref “Organizations”), Internal use and also for insurance and promotion purposes made from/by the above organizations with regard to specific use of name, image and likeness .......................

To allow the use of my personal data for marketing purposes and receive commercial messages linked to products and services of the above Organizations, partner companies, and sponsors of the events.

To Allow the use of my personal data captured for relative use of audio and video material (interviews, videos, Photos and social media content) made during social occasions and general program events and activities of the Organizations, partner companies, and sponsor promotions used for pre and post program marketing.

(Please Note: Without Agreeing with this term it will be not possible to carry on with participation and membership procedures.)

WE HEREBY DELCLARE AND ACCEPT

That we know and are aware of the policies and regulations of the above mentioned organizations and I fully accept them;

That we know and are aware of the general insurance coverage granted by participation in the above programs.” The person covered by insurance must do all that is reasonably possible to avoid injuries and/or to not cause them as reasonably as possible”;

That we know and are aware of the Professional Code of Conduct and will adhere to its representations fully; for my wellbeing and safety, as well as the wellbeing and safety of my fellow program participants and staff.

That we know and are aware of general applications of medical assistance on sport activities and consequence and obligations due to athletics and contact sports;

That We/I the student do not have any illness and/or disease that are not recommended for sport activities/physical exertion and for that reason We/I hereby attach a medical certificate that declare that We/I am able to participate in sports and physical activities required under this program;

That I as the legal parent/guardian take the commitment to pay the full price amount of $2,527.USD in three equal installments of $842.00USD (Eight Hundred Forty Two Dollars) paid per instructions in accordance with “Timeline Participation” for the above mentioned program activities not later than March 1ST, 2023. Payment will be made in accordance to program timeline and instructions via bank wire transfer to the IBAN Code: IT14V0623036750000030018830, BIC.COD.: CRPPIT2P735, C.A.B.: 36750, ABI Cod.:06230; directed to David L. Rivers on behalf of Global Sports & Education LLC., TAX ID: 88-233679, Registered Address:10804 Laurel Glen Place, Tampa, Florida 33626

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.

Data

EVENTS & PROGRAMS REGISTRATION FORM