HFM Summer PARTICIPANT FORM Logo
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  • Student Registration

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  • Parent/Guardian Info

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  • Emergency Contact

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  • Confirm Dates Attending

    Please select all the dates and times your child will be participating. We offer a robust selection, including multiple sessions on the same day at different locations. Transportation is not provided; however, we welcome and encourage participants to attend both.
  • Legend:

    CPL = Cochran Public Library, 174 Burke Street, Stockbridge, GA 30281

    Early afternoon hours (Select days from 1pm to 3pm and 2pm to 4pm)

     

    FRC = Fairview Recreation Center, 35 Austin Rd, Stockbridge, GA 30281

    Early evening hours (Select days from 6pm to 8pm)

     

    * Early Voting = Venue subject to change due to Early voting

  • Deliverables

  • Waivers & Release

  • Medical Release and Authorization. As Parent and/or Guardian of the named Participant, 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 HFM 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.

    Informed Consent and Acknowledgement. I hereby approve the named Participant to participate in any activities Henry For Music, Inc. (HFM) has prepared during the selected sessions including but not limited to content creation, which will be used to increase program awareness via deliverables, including but not limited to advertisements, media campaigns, etc. exchange for the acceptance of said participant's candidacy by HFM. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve, and hold harmless HFM and all its respective officers, agents, and representatives from any 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 HFM, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. 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.

    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.

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