RBAxJR NBA SUMMER BREAK CAMP

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PLAYER'S NAME* This field is required.

First Name

Last Name

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PLAYER'S DATE OF BIRTH* This field is required.

Date

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PLAYER'S AGE* This field is required.

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SUMMER BREAK CAMP WEEK* This field is required.SELECT THE WEEK YOU WOULD LIKE TO ATTEND

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PARENT/LEGAL GUARDIAN NAME* This field is required.

First Name

Last Name

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PARENT/LEGAL GUARDIAN PHONE NUMBER* This field is required.

Please enter a valid phone number.

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PARENT/LEGAL GUARDIAN EMAIL* This field is required.

example@example.com

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EMERGENCY CONTACT* This field is required.

NAME OF EMERGENCY CONTACT

PHONE NUMBER

RELATIONSHIP TO PLAYER

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PARENT/LEGAL GUARDIAN SIGNATURE* This field is required.

Clear

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JNYB WAIVER & RELEASE OF LIABILITY
In consideration of being premitted to participate in JYNB programming and related activities, the undersigned acknowledges, appreciates, and agrees that:

1. The risk of injury from activities involved in JNYB is significant, and while rules, equipment, and personal discipline may reduce the risk, the risk does exist;
2. I knowingly and freely assume that all such risks, known and unknown, even if arising from the negligence of NBA Canada, Canada Basketball, referees, volunteers, and/or employees, players, sponsors, advertisers, and if applicable, owners/lessors or premises used, and any related events and/or activities (the releasee(s)), and assume full responsibility for my participation;
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe my unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately;
4. I, for myself on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release and hold harmless the releases, with respect to any and all injury, disability, loss or damage to person or property, whether caused by the negligence of the releasee(s) or otherwise;
5. i further agree to irrevocably grant NBA Canada, Canada basketball, and their affiliated Provincial/Territorial Sports Organizations or assigns, the prepetual unlimited world-wide and royally free rights to record, reproduce, broadcast, exhibit, publish, sell, distribute, or use in any way whatsoever my name and likeness in any media, whether now known or hereafter developed, in connection with my attendance and participation in the JNYB program, including without limitation a video tape recording of such performance. I agree that I shall have no claim, title or intrest to my attendance or participation or any materials produced hereunder.

This is to certify that I, as a parent/guardian with legal responsibility for this participant, consent and agree to his/her release as provided by all of the releasee(s), and for myself, my heirs, assigns, and next of kin, I have read this waiver and release of liability. I fully understand its terms and agree to indemnity the releasee(s) from any and all liabilities to my minor child's involvement or participation in the program as provided above. Also, I confirm that the above information is true and correct to the best of my knowledge.

Signature *
Parent/Guardian Signature

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DEPOSIT & FEE DUE DATES
Payment to be made on our website www.retrobasketballacademy.com

I Parent/Legal Guardian First Name * Parent/Legal Guardian Last Name * agree to submit fees for Retro Basketball Academy's Jr. NBA Summer Camp by the given deadlines.