Boutique Basketball Inc. Training Registration Form.

Athlete's Name*

First NameLast Name

Birth Date*

MonthDayYear

Athlete's E-mail*

example@example.com

Phone Number

Area CodePhone Number

Current Grade Enrolled in at School*

Athlete's Dominant Playing Hand?*

LeftRight

Positions Played*

Positions Preferred*

Primary E-Mail (Note: this is the email account that will receive invoices)*

Mom's/Female Guardian name*

First NameLast Name

E-mail*

Mom's Phone Number*

Area CodePhone Number

Dad's/Male Guardian Name*

First NameLast Name

E-mail*

Dad's Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Home Phone Number*

Area CodePhone Number

Informed Consent/General Release-Youth Basketball Participants

PLEASE READ CAREFULLY AND SIGN BELOW TO INDICATE YOUR AGREEMENT.
NOTE: THIS FORM INCLUDES A RELEASE OF LIABILITY.

Since participation in youth sports activities can be dangerous, Boutique Basketball Inc. and The Boutique Foundation requires that all participants (and their adult parent(s) or guardians) to assume all risks associated with youth basketball training by signing this general release.

For and in consideration of my child being permitted to participate in Boutique Basketball's Elite Training & Development, I hereby voluntarily release, discharge, waive and relinquish any and all claims or actions for damages for personal injury, permanent disability, death, or property damage which I or my child may have, or which may here after accrue to me or my child, as a result of my participation in youth basketball activities during play and while I am at the facility while others play or for any other reason. This release is intended to discharge, in advance, Boutique Basketball Inc., it’s affiliates, officers, employees and agents, and the owners and maintainers of any facility used for basketball training or activities, from any and all liability arising out of or connected in any way with my child’s participation

in basketball camps/clinic activities, even though that liability may arise out of negligence or carelessness on the part of Boutique Basketball Inc, its affiliates, officers, agents or employees, or the owners or maintainers of any facility used by Boutique Basketball Inc. or The Boutique Foundation for basketball training or activities.

I further understand that serious accidents occasionally occur during youth basketball activities, and that participants occasionally sustain serious personal injuries, death or property damage as a consequence thereof. Knowing the risks, I have voluntarily applied for my child to participate in the activity and thereby agree to assume those risks to release and hold harmless Boutique Basketball Inc, its affiliates, officers, employees or agents, or the owners or maintainers of any facility used by Boutique Basketball Inc for basketball training or activities, who (through negligence or carelessness) might otherwise be liable to me or to my child (or my heirs or assigns) for damages.

I further understand and agree that this release, discharge, waiver, and assumption of risk is to be binding on my and my child’s heirs, executors, administrators, and assigns.

I further agree to indemnify and to hold harmless Boutique Basketball Inc., its affiliates, officers, employees and agents, or the owners or maintainers of any facility used by the Boutique Basketball Inc. for basketball training or activities, for any loss, liability damage, cost or expense which may incur as a result of any injury or property damage I or my child may sustain while participating in the activity.

I agree to comply with the program’s stated and customary terms and conditions for participation according to Boutique Basketball Inc. If I observe any significant change with regards to my child’s readiness for participation in the program, I will remove my child from the program immediately.

I have read this Informed Consent/General Release, fully understanding its terms, that I give up substantial rights by signing it, and sign it voluntarily.

DO NOT E-SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT.

By my eSignature below, I certify that I have read, fully understand and accept all terms of the foregoing statement. Please signify your acceptance by entering your full name in the box below

Waiver of Liability Signature*

I accept the terms listed in the agreement above

Parent's eSignature*

Boutique Basketball Training Registration Form