Backboard Basics Registration Form

Athlete Information

Player Name*

First NameLast Name

Player Name (sibling)

First NameLast Name

School

School Email*

Guardian / Parents Names*

First NameLast Name

Guardian / Parents Names*

First NameLast Name

Home Phone*

Format: (000) 000-0000.

Cell Phone

Format: (000) 000-0000.

E-mail*

example@example.com

Basketball skill level*

1 is Begginer, 5 is Advanced

Emergency Contact Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Format: (000) 000-0000.

Important Notes

· Dress appropriately.

· No food or drink in the gym (water only)

· Keep the gym clean.

· Fee: $200 per participant. Sibling discounts are available ($150/sibling).

YesNo

Please describe*

Release of Liability

Although the safety of all sport activities is the primary concern, indoor sport activities facilitated by Backboard Basics may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Backboard Basics program and the persons in charge.

Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I give consent for the facility to secure any and all necessary emergency medical care for my child.

YesNo

Photo Release Form

We, at Backboard Basics, would be from time to time taking photos of players during their activities within the premises. In this regard, we seek your consent for the publishing or use of photos which your child may be included.

Photos will be used for marketing or advertising, and/or marketing updates posted via social pages, or website.

Should you decide ot take back your authorization later on, you may do so by writing to us.

For protection of privacy of the child, we guarantee that names will not be included

YesNo

Confirmation E-mail*

example@example.com

Signature*

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

Fees*

Backboard Basics School Training

Group basketball training at child's elementary school.

$200.00

Sibling Backboard Basics School Training

Siblings (2x) are discounted for school group basketball training.

$300.00

Total

$0.00

Credit Card