Mini Session Basketball Clinics For Autism and Special Needs. 6:00pm-8:00pm
*Monday Night Session* Dobie High School
Email
*
example@example.com
Name of Event
*
Participant's Name
*
Gender
*
Male
Female
Other
Race
*
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Pacific Islander
White
Other
Date of Birth
*
-
Month
-
Day
Year
Parent/Guardian Name
*
Home Address
*
Phone
*
Please enter a valid phone number.
Alternate Number
*
Please enter a valid phone number.
Any medical conditions or food allergies?
*
Emergency Contact Number
*
Please enter a valid phone number.
School
*
Grade
*
T-Shirt Size
*
XS
S
M
L
XL
XXL
THE PARENT/GUARDIAN OF THE ABOVE NAME CHILD, HEREBY GIVE MY APPROVAL OF HIS/HER PARTICIPATION IN ALL BASKETBALL/SPORTING ACTIVITIES. I ASSUME ALL RISKS AND HAZARDS INCIDENTAL TO SUCH PARTICIPATION. I DO HEREBY WAIVE, RELEASE, ABSOLVE AND AGREE TO HOLD THIS FACILITY AND BE A NINTH WONDER FOUNDATION, INC, COACHES AND OFFICIALS FROM ANY CLAIMS WHICH MIGHT ARISE FROM INJURIES SUSTAINED WHILE PARTICIPATING IN THIS EVENT. PICTURES AND VIDEOS WILL BE TAKEN DURING EVENTS. THEREFORE I/WE THE PARENT/GUARDIAN OF THE ABOVE NAME PARTICIPANT, GIVE BE A 9TH WONDER FOUNDATION PERMISSION TO USE THE ABOVE NAME PARTICIPANT’S PICTURE AND OR VIDEO ON WEBSITES (SUCH AS FACEBOOK, INSTAGRAM OR OTHER SOCIAL MEDIA ENTITIES) TAKEN DURING TRAINING SESSIONS,CAMPS OR WORKOUTS FOR PROMOTION PURPOSES ONLY.
*
CHECK HERE IF YOU AGREE
I hereby grant the United Way of Greater Houston permission to use my likeness in a photograph/video, reference me and my story in any and all of its publications, including website and social media forums, without payment or any other consideration. I understand and agree that these materials will become the property of the United Way of Greater Houston. I hereby authorize the United Way of Greater Houston to edit, alter, copy, exhibit, publish or distribute this content for purposes of publicizing the United Way of Greater Houston or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness or story appears. I am 18 years of age and am competent to contract in my own name. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release.
*
CHECK HERE IF YOU AGREE
For grant purposes, please indicate your household income
*
Below 30,000 annually
31,000-50,000 annually
Above 51,000 annually
Please read and agree COVID-19 Safety Acknowledgement And Liability Waiver https://ninthwonder.org/covid-19-safety-acknowledgement-and-liability-waiver/
*
CHECK HERE IF YOU AGREE
A copy of your responses will be emailed to the address that you provided.
Submit
Should be Empty: