Fall Ball Skills Registration Form

Fall Ball Basketball Registration

Paso Robles High School Practice Gym
Designed to Support North County Communities

Co-Ed 3rd-8th Grade

5 Sessions (Sept 22-Oct 20)

Mondays 6:30pm-7:45pm

The 3Ball Basketball Skills program is all about having fun, working hard, and being a great teammate.

Through drills, games, and teamwork activities, led by 3Ball coaching staff, players will sharpen their dribbling, shooting, passing, and defense.

3Ball creates a supportive, high-energy environment where kids can grow on and off the court.

LEARN MORE about our 3Ball coaches. The program is led by Mike Wozniak and Justin Lourenco, who combine playing and coaching experience with a commitment to building skills, confidence, and teamwork in every athlete.
Program Fee Options

Full Session (5 weeks): $125

Single Session Drop-In: $30

Walk-ins Welcome
Scholarships Available

Thanks to support from Justin Winery, we’re able to offer a limited number of scholarships for eligible Paso Robles Joint Unified School District students. Eligible students must be enrolled in the PRJUSD free/reduced lunch program. If you would like to apply for a scholarship, please check the box below certifying eligibility. We’ll contact you within 48-72 hours to confirm eligibility.

Note: If a scholarship is not available, you are still welcome to participate by completing registration.
I certify that the participating student is currently enrolled in the PRJUSD free/reduced lunch program.

Yes
Student Information
Would you like to register multiple students?
Student's Name*

First NameLast Name
1st Student's Name*

First NameLast Name
2nd Student's Name*

First NameLast Name
3rd Student's Name

First NameLast Name
Birth Date*

MonthDayYear
1st Student's Birth Date*

MonthDayYear
2nd Student's Birth Date*

MonthDayYear
3rd Student's Birth Date

MonthDayYear
Student's Grade*
1st Student's Grade*
2nd Student's Grade*
3rd Student's Grade
Student's School*
Student's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Home Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship
Phone Number*
Alt. Phone Number
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the student prescribed an inhaler? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by 3Ball Academy during the selected program. In exchange for the acceptance of said child’s candidacy by 3Ball Academy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve, and hold harmless 3Ball Academy and all its respective officers, agents, and representatives 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 3Ball Academy, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. I understand there is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

I also grant 3Ball Academy permission to photograph and/or record my child during program activities. I understand that these photos and videos may be used for training, promotional, and marketing purposes in print, digital, and online formats. I waive any right to compensation arising from or related to the use of such images or recordings.
Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment 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 surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every 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 the 3Ball Academy and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical 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 medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

Clear

Scholarship Code

You have certified that the participating student is currently enrolled in the PRJUSD free/reduced lunch program. Please use the scholarship code below to register for the Fall Ball program.

Code: PRJUSD

Waitlist Option

If you enter the code PRJUSD and receive an error message, it means our scholarship spots have already been filled.

Don’t worry—you can still reserve a place on our scholarship waitlist! To join, simply enter the code WAITLIST during registration. If additional scholarships become available, families on the waitlist will be contacted in the order they signed up.

Registration Fees*

(5) Session - Program Registration

$125.00 Quantity

Single Class Drop-in Registration

$30.00 Quantity

Enter coupon

Total

$0.00

We’d like to hear about what sparked your interest in the after school basketball class and your child's sports experience, including their recent activities and passion. How would you describe their focus and ability to work with others? Lastly, please share any goals or preferences you have for your child's after school experience.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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Fall Ball Basketball Registration

Co-Ed 3rd-8th Grade

5 Sessions (Sept 22-Oct 20)

Mondays 6:30pm-7:45pm

Student Information