2023 Assist 13 Hoops Camp Registration

Participant's Name*

First NameLast Name

Age*

Gender*

Select Camp Session(s)*

Session I

Alexander High School - 9th Grade Campus GYM AUGUST 5th - Ages 5 yrs - 8 yrs old 9:00AM - 12:30PM

$25.00 Quantity

Session II

Alexander High School - 9th Grade Campus GYM AUGUST 5th - Ages 9 yrs - 12 yrs old 1:00PM - 4:30PM

$25.00 Quantity

Session III

Martin High School - MAIN Campus GYM AUGUST 6th - Ages 5 yrs - 8 yrs old 8:30AM -11:30AM

$20.00 Quantity

Session IV

Martin High School - MAIN Campus GYM AUGUST 6th - Ages 9 yrs - 12 yrs old 12:00PM - 3:00PM

$20.00 Quantity

Enter coupon

Total

$0.00

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Email*

example@example.com

Parent/Guardian Contact Number*

This number will be used during the camp session for emergency purposes only.

Emergency Contact (other than parent/guardian listed above)*

Emergency Contact Number*

Please enter a valid phone number.

Medication or Medical Condition/Allergies (if none, enter N/A)

Please be sure to let the Assist 13 Staff know about any specifics we should know about your child.

Participant Waiver (Each participant is required to have a waiver on file to attend camp). In consideration for allowing the above camper (“Minor”) to participate in the Assist 13 Basketball Camp Hosted by Kaleb Canales (the “Event”) held at Alexander High School Campus Gymnasium/Martin High School Gymnasium (“Venues”), I, as the parent and/or legal guardian of Minor, for myself, and on behalf of Minor and his/her parents, heirs, executors, administrators, next of kin, successors, and assigns, all of whom shall be legally bound by this release, hereby agrees as follows: 1. Minors under 18 years of age and I am 18 years of age or older. I acknowledge that Minor is not required to participate in the Event. His/her participation is voluntary and solely for Minor’s benefit and entertainment. I understand that said Minor can withdraw from the Event at any time. We understand there are inherent risk associated with Minor’s participation and use of either Venue. We understand and acknowledge that basketball is an action sport that may present a significant risk of personal injury to Minor. We further understand and acknowledge that Minor’s participation in the Event may require him/her to engage in strenuous and/or potentially dangerous activities. Neither Minor nor I are aware of any reason, medical or otherwise, why Minor should not participate in the event, and we are prepared to, and do, hereby accept any and all risks, whether known or unknown to Minor and/or me, of having Minor participate in the Event. 2. Minor and I agree to indemnify, release, forever discharge and hold harmless, and I covenant not to sue, the hosts and their respective partners, owners, stockholders, directors, officers, employees, agents, representatives, heirs, successors, and assigns, and each and every person acting by, through, under, or in concert with them, or any of them (hereinafter individually and collectively referred to as the (“Indemnified Parties”), of and from all manner of action or actions, cause or causes of action, at law or in equity, suits, claims, demands, damages, liability, lost cost or expense, of any nature whatsoever, known or unknown, fixed or contingent (hereinafter referred to as “Claims”) which Minor and/or I may have or hereafter have against the Indemnified Parties by reason of any injuries/illness/covid-19 that Minor may sustain, whether to his/her person and/or property, as a result of or incident to the Indemnified Parties’ negligence (whether active or passive), Minor’s participation in the Event, and/or any and all risks assumed by Minor and/or me hereunder. 3. I hereby authorize and grant the right to Indemnified Parties and/or anyone authorized by them or acting on their behalf to use, record, reproduce, publish or depict my voice, recording, photograph, and/or likeness, in any manner that they deem necessary or appropriate, in all media, worldwide perpetuity, in and in connection with the production, distribution, marketing, promotion, advertisement, packaging, sale, publication, exhibition, and/or exploitation of the Event, including, without limitation, in any and all print advertisements, broadcasts, telecasts, and/or retransmissions of or regarding the Event. This may be done without any further permission from me and without any fee or other compensation to me.*

I understand

Parent/Guardian Signature*

Date*

Date

Please select your payment method below:

NOTE: If you are using a discount code, you MUST supply a form of payment at check out.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

2023 Back to School Assist 13 Summer Hoops Camp