Valpo Hoops Skills Academy 2024
* Player Name
First Name
Last Name
What school does your child attend?
Cooks Corners
Flint Lake
Northview
Memorial
Parkview
Heavilin
Central
TJE
Ben Franklin
Thomas Jefferson
Immanuel
St. Paul
Other
T-Shirt Size
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Youth Large
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Choose your Academy
Boys
Girls
Does your Son or Daughter have any Allergies, Medical Conditions, Chronic Illnesses, or other conditions that might limit Activity
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Yes
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Emergency Contact Information and Insurance Information
Parent or Guardian Name
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Insurance Carrier
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As the legal parent or guardian, in the event of illness or accident, I give consent for the Valpo Boys Hoops LLC and its Staff to secure any and all necessary emergency medical care for my child. The undersigned gives permission to Valpo Boys Hoops LLC and its owners and operators and members of the Valparaiso High School Boys & Girls Basketball Coaching staff to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I request that my child be transported to Northwest Health Porter Hospital in the event of an emergency. I hereby declare we have listed any physical/mental problems, restrictions, or conditions and/or declare the participant to be in good enough physical and mental health to participate in basketball practice and games.
As the legal parent or guardian, I release and hold harmless Valpo Boys Hoops LLC, its owners and operators, and its Coaching Staff, and the Valparaiso Community School Corporation from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Valpo Boys Hoops LLC and Valpo Hoops LLC, its owners and operators or in route to or from any of said premises.
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Fall Session
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