Fastbreak Sports Basketball Inquiry Form

Player Name*

First NameLast Name

Player E-mail*

Player Phone Number*

Area CodePhone Number

Parent Name*

First NameLast Name

Parent Email*

example@example.com

Parent Phone Number:*

Area CodePhone Number

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Current School*

Current Grade *

Playing Experience*

Release of Liability:

I understand there are risks associated with all activities including Basketball activities. I agree not to hold the Fastbreak Sports, its directors, officers, agents and volunteers liable for any claims of damages or injury to me or my property that may occur through the normal course of Basketball. I understand the Fastbreak Sports leadership will make every reasonable attempt to provide a safe environment for the tryouts. Medical Custody Release: I authorize the Leadership of the Fastbreak Sports to seek and authorize medical attention in the event I need medical care for emergency reasons. I understand a call will be made to the parents/guardians, however, if contact cannot be made on first call, assistance will be authorized by the Fastbreak Sports leaders. Zero Tolerance Policy: I accept that Fastbreak Sports has a zero tolerance policy for any violence or aggressive language. I understand that any violation of this policy will result in immediate removal from the tryout. MEDIA WAIVER: I do hereby grant unlimited permission to Fastbreak Sports to photograph/video and to publish the said photograph(s)/video(s) of myself, in whole or partially, on the Fastbreak Sports website and in related Fastbreak Sports promotional brochures, advertisements and videos for the purpose of promoting the Fastbreak Sports Program. I hereby waive all rights of privacy and/or compensation for me which I, or she/he, may have in connection with the use of my, or her/his, photograph, likeness, depiction or story, or any or all of them, in or in connection with said Fastbreak Sports websites, still photography, or video/film and any use to which the same or any material therein may be put, applied or adapted by Fastbreak Sports in connection with the promotion of Fastbreak Sports. I hereby grant the Fastbreak Sports permission to edit, crop, or retouch such photographs, and waive any right to inspect the final photographs.

I have read, understood, and ACCEPT the terms above.I have read, understood, and DO NOT ACCEPT the terms above.

Once you submit your application, we will contact you shortly in regards to your inquiry

Thank you!

Fastbreak Sports Staff