Next Level Athletic Academy Enrollment Application

Thank you for your interest in enrolling in Next Level Athletic Academy. This application is for participation in our Basketball Skills Development Training, Athletic Performance Enhancement Training, and Travel Team opportunities.

Please ensure that all sections of this application are completed accurately and in full. Incomplete forms may delay the processing of your application.

Today's Date*

I. Parent/Legal Guardian

*Parents/Legal Guardian Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

*Parent/Legal Guardian Email*

example@example.com

Parents / Legal Guardian Name (optional)

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Current Address*

Street Address

Street Address Line 2

CityState

Zip Code

II. Athlete/Participant Information

Name*

First NameMiddle NameLast Name

Non-Traditional Students Association/Organization

Date of Birth*

Current Age*

Gender*

MaleFemaleN/A

Classification/Grade Level*

2nd - 4th5th - 7th8th - 9thOther

Phone Number

Please enter a valid phone number.

Email

example@example.com

Participant/Athlete Address (if different from current address)

Street Address

Street Address Line 2

CityState

Zip Code

Basketball Experience*

BEGINNER - Introduction to basketball fundamentals (dribbling, passing, shooting, and motor skills like coordination, balance, and agility.INTERMEDIATE - Focus on refining individual skills (shooting accuracy, ball handling, footwork), spacing, movement w/out the ball, defensive schemes, and increasing conditioning and physical endurance.ADVANCED - Focus on advanced skill development (specialized shooting drills, advanced dribbling techniques, defensive tactics), leadership and mental toughness training, and physical conditioning with an emphasis on speed, agility, and strength.

Athlete Goals and Commitment Level*

Recreational Player: Wanting to have fun, stay active, and enjoy the game.Fitness and Development: Aiming to improve my athletic abilities and basketball skills.Competitive Player: Looking to compete at a high level in games and tournaments.College Aspirations: Goal is to play basketball at the collegiate level.Professional Ambitions: Dedicated to pursuing basketball as a professional career.

NLAA Team Participation Interest*

Yes, I am interested in joining the teamNo, I am not interested in joining the team, but I would like to participate in the program for skill development and training only.

T-Shirt Size*

IIa. Participant's Medical History

1. Does the participant have any current injuries or physical conditions that might limit your ability to participate in basketball training or physical activities?*

NoYes

If yes, please specify:

2. Has the participant experienced pain, discomfort, or significant fatigue during physical activity in the past 12 months?*

NoYes

If yes, please specify:

3. Has the participant been diagnosed with any of the following conditions? Check all that apply or select "None of the Above".

Asthma or other respiratory conditionsMuscle, joint, or bone injuries (e.g., sprains, fractures, or chronic pain)None of the aboveOther

If yes, please specify:

4. Does the participant have any allergies that could be triggered during physical activity (e.g., exercise-induced asthma, environmental allergies)?*

NoYes

If yes, please specify:

5. Has the participant undergone any surgeries in the past year?*

NoYes

If yes, please specify:

6. Does the participant take any medications or supplements that could impact your athletic performance or physical activity?*

NoYes

If yes, please specify:

7. Has the participant ever been advised by a doctor or healthcare professional to restrict your physical activity?*

NoYes

If yes, please specify:

8. Is the participant currently experiencing any of the following symptoms during physical activity?*

If yes, please specify:

9. Do you know of any other reasons why the participant should not undergo physical activity? This might include diabetes, a recent injury, or serious illness.*

NoYes

If yes, please specify:

If you answered ‘YES’ to any of the above questions medical clearance from your child’s physician may be required.

IIb. Emergency Contacts

Emergency Contact Name*

First NameLast Name

Relationship*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Alternate Emergency Contact

First NameLast Name

Relationship

Phone Number

Please enter a valid phone number.

Email

example@example.com

Acknowledgment

I hereby declare that all the information provided above is accurate and complete to the best of my knowledge. I understand that participation in the Next Level Athletic Academy programs involves physical activity, and I agree to notify the staff of any changes in my health or fitness status.

I understand that my child is responsible for monitoring him or herself throughout any activity and, should any unusual symptoms occur, would ease participation and inform the instructor.

If medical clearance must be obtained before my child’s participation in an exercise
session, I agree to contact the child’s physician and obtain written permission prior to the commencement of the exercise activity, and that the permission be given to the instructor.

Child/Participant Name*

First NameLast Name

Age*

In signing this form, I, the parent/guardian of the aforementioned child, affirm that I have read this form in its entirety and I have answered the questions accurately and to the best of my knowledge.

Parent/Legal Guardian Name*

First NameLast Name

Parent/Legal Guardian Signature*

Parent/Legal Guardian

III. SPORT PARTICIPANT RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

I, print/type name* do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with, Kwan L. Johnson Sr., The Venue, and Property Owner, transportation of equipment related to the activities, and traveling to and from activity sites in which I am about to engage. Inherent hazards and risks include but are not limited to:

1. Risk of injury from the activity and equipment utilized is significant including the potential for broken bones, severe injuries to the head, neck, and back or other bodily injuries that my result in permanent disability and death.
2. Possible equipment failure and/or malfunction or misuse of my own or others’ equipment.
3. I AGREE THAT I WILL WEAR APPROVED PROTECTIVE GEAR AS DECREED BY THE GOVERNING BODY OF THE SPORT I AM PARTICIPATING IN. However, protective gear cannot guarantee the participant’s safety. I further agree that no helmet can protect the wearer against all potential head injuries or prevent injury to the wearer’s face, neck or spinal cord.
4. Variation and/or steepness of terrain, variation or changes in surfaces including but not limited to snow surfaces, ice, bare spots, rocks, stumps, debris, cliffs, trees, fences, posts, trees, light poles, signs, buildings, roads, walkways, ramps, rails, stairs, pyramids, manual pads, bowls, half-pipes, jumps, padded and non-padded barriers, other persons, and other natural and man-made hazards.
5. My own negligence and/or the negligence of others, including but not limited to operator error and guide decision making including misjudging terrain, weather, riding surfaces or other obstacles.
6. Exposure to the elements and temperature extremes may result in frost nip, frost bite, heat exhaustion, heat stroke, sunburn, hypothermia, and dehydration.
7. Dangers associated with exposure to natural elements include but are not limited to avalanche, rock fall, inclement weather, thunder, and lightning, severe and or varied wind, temperature and other weather conditions.
8. Accidents or illness occurring in remote places where there are no available medical facilities.
9. Fatigue, exhaustion, chill, and/or dizziness, which may diminish my/our reaction time and increase the risk of accident.
10. Impact or collision with other athletes, spectators, facility employees, pedestrians, motor vehicles, and cyclists.
11. I understand the description of these risks is not complete and unknown or unanticipated risks may result in injury, illness, or death.

Release of Liability, Waiver of Claims, and Indemnity Agreement In consideration for being permitted to participate in the above-described activity(s) and related activities, I hereby agree, acknowledge and appreciate that:

I HEREBY RELEASE AND HOLD HARMLESS WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE, the following named persons or entities, herein referred to as releasees.

Kwan L. Johnson Sr., The Venue, & Property Owner

Company and/or Person

To release the releasees, their officers, directors, employees, representatives, agents, volunteers, and the venue (training location) from liability and responsibility whatsoever and for any claims or causes of action that I, my estate, heirs, survivors, executors, or assigns may have for personal injury, property damage, or wrongful death arising from the above activities whether caused by active or passive negligence of the releasees or otherwise. By executing this document, I agree to hold the releasees harmless and indemnify them in conjunction with any injury, disability, death, or loss or damage to person or property that may occur as a result of my engaging in the above activities.
By entering into this Agreement, I am not relying on any oral or written representation or statements made by the releasees, other than what is set forth in this Agreement.
This agreement shall apply to any and all injury, disability, death, or loss or damage to person or property occurring at any time after the execution of this agreement. This release shall be binding to the fullest extent permitted by law. If any provision of this release is found to be unenforceable, the remaining terms shall be enforceable.

FOR PARTICIPANTS OF MINORITY AGE: This is to certify that I, as Parent, Guardian, Temporary Guardian with legal responsibility for this participant, do consent and agree not only to his/her release of all Releasees, but also to release and indemnify the Releasees from any and all liabilities incident to his/her involvement in these programs for myself, my heirs, assigns, and next of kin.

Name of Participant*

First NameLast Name

Participant's Age*

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, I FULLY UNDERSTAND ITS TERMS, I UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Parent/Legal Guardian Name*

First NameLast Name

Parent/Legal Guardian Signature*

IV. NEXT LEVEL ATHLETIC ACADEMY MEDIA RELEASE FORM

I, First Name Last Name hereby grant KWAN L. JOHNSON & NEXT LEVEL ATHLETIC ENHANCEMENTS the permission to use my likeness in a photograph, video, social media, or other digital and printed media in all of its publications without payment or other consideration. I understand and agree that all media will become the property of the KWAN L. JOHNSON & NEXT LEVEL ATHLETIC ENHANCEMENTS and will not be returned.
I hereby irrevocably authorize the KWAN L. JOHNSON & NEXT LEVEL ATHLETIC ENHANCEMENTS to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.
I hereby hold harmless, release, and forever discharge the KWAN L. JOHNSON & NEXT LEVEL ATHLETIC ENHANCEMENTS from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

FOR PARTICIPANTS OF MINORITY AGE: This is to certify that I, as Parent, Guardian, Temporary Guardian with legal responsibility for this participant, do consent and agree not only to his/her release of all Releasees, but also to release and indemnify the Releasees from any and all liabilities incident to his/her involvement in these programs for myself, my heirs, assigns, and next of kin.

I HAVE READ AND UNDERSTAND THE ABOVE MEDIA RELEASE. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, I FULLY UNDERSTAND ITS TERMS, I UNDERSTAND THAT I HAVE GIVEN UP LEGAL RIGHTS BY SIGNING IT, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Name of Participant*

First NameLast Name

Participant's Age*

Date*

Parent/Legal Guardian*

First NameLast Name

Parent/Legal Guardian*

Next Level Athletic Academy Daily Schedule
	Beginner	Intermediate	Advanced
Monday	9:30a-10:45a	11a-12:30p	12:45p-2:45p
Tuesday	9:30a-10:45a	11a-12:30p	12:45p-2:45p
Wednesday	9:30a-10:45a	11a-12:30p	12:45p-2:45p
Thursday	9:30a-10:45a	11a-12:30p	12:45p-2:45p
*Subject to change, check website regularly.

Next Level Athletic Academy Basketball Development Packages (ages 8-13)*

Triple Threat - 3 Sessions Product Image

Triple Threat - 3 Sessions$40/Session - 3 sessions, 1-2 weeks. *Must be completed within 2 weeks of purchase.

$120.00

Testing the Waters - 8 Sessions Product Image

Testing the Waters - 8 Sessions $35 /Session - 1 month, 8 sessions, 2-3 sessions per week. *Must be completed within 4 weeks of purchase. 10% Discount Code: " HoopsHeritage10 "

$280.00

Lionheart - 1 Month Unlimited Product Image

Lionheart - 1 Month Unlimited$350 - 1 month, $25/ day - 14 available days, 3-6 sessions per week, 1-2 sessions per day, 14+ sessions for 1 Month. *Must be completed within 5 weeks of purchase. 20% Discount Code: "Coastal20Culture"

$350.00

Grind to Greatness - 3 Months Unlimited, $280/Month Product Image

Grind to Greatness - 3 Months Unlimited, $280/Month$840 = $280/Month, $20/Day - 3 months, 14 available days per month, 3-6 sessions per week, 1-2 sessions per day, 14+ sessions per Month. *Must be completed within 3 months and 5 days of purchase. 15% Discount Code: "GrandStrandGrind15"

$840.00

Exposure Accelerator - 6 Months Unlimited, $210/Month. Product Image

Exposure Accelerator - 6 Months Unlimited, $210/Month.$1,260 = $210 per Month, $15/Day- 6 months, 14 available days per month, 3-6 sessions per week, 1-2 sessions per day. *Must be completed within 6 months and 5 days of purchase. 10% Discount Code: " HoopsHeritage10 "

$1,260.00

Enter coupon

Subtotal

$0.00

Tax

$0.00

Total

$0.00

NEXT LEVEL ATHLETIC ACADEMY

Registration Form