Kidnetics All Levels Basketball Camp

$350 per hooper. Includes $100 non-refundable administration fee that will be applied toward thecost of the entire clinic. Payments may be paid monthly( $125 a month) or in full. Each sessionwill be 150 minutes in length and will be led a skilled occupational therapist and another supportstaff. Each session is aimed to have 12 or fewer participants per session to maintain a lowcamper to staff ratio and ensure personal attention and a positive experience for all participants.Our basketball camp is designed for individuals with sensory processing differences, and is ledby a skilled and compassionate occupational therapist who understands their needs and tailorsthe program accordingly. The clinic is 5 sessions total and runs from July 14-18, Monday toFriday from 10:00am-12:30pm. After registering your child, you will receive an invoice from Kidnetics Pediatric Therapy which you may pay by check, credit card, or through our online system. If paying by check, please mail to: Kidnetics Pediatric Therapy, 29 Yarrow Way, Santa Rosa CA

I hereby give my approval for my child’s participation in any and all activities prepared by Kidnetics Pediatric Therapy during the selected camp. In exchange for the acceptance of said child’s candidacy by Kidnetics Pediatric Therapy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Kidnetics Pediatric Therapy and all its respective officers, agents, andrepresentatives 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 child, I hereby waive all claims against Kidnetics Pediatric Therapy including allstaff, coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, ownersand lessors of premises used to conduct the event. There is a risk of being injured that is inherent in allsports activities, including basketball. Some of these injuries include but are not limited to, the risk offractures, paralysis, or death.Any controversy or claim arising out of or related to my child(ren)’s participation in this group will beattempted to be settled by a professional mediation service,

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by aqualified and licensed medical professional, of the minor child, in the event of a medical emergency, whichin the opinion of the attending medical professional, requires immediate attention to prevent furtherendangerment 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 surgicaltreatment, x-ray examination, and immunizations for the named athlete. In the event of an emergencyarising out of serious illness, the need for major surgery, or significant accidental injury, I understand thatevery 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 Kidnetics Pediatric Therapy and its affiliates including Therapists, Coaches,and other employees to provide the needed emergency treatment prior to the child’s admission to themedical 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 medicaltreatment under emergency circumstances, for the protection of life and limb of the named minor child, inmy absence.