Skill Drills Registration Form 2025-2026

Which sessions are you signing up for ($5 each)?*

Basketball - Fall Saturdays - 9/27, 10/4, 10/11, 10/18, 10/25, 11/1Soccer - Winter Saturdays - 1/24/26-2/28/26Volleyball - Spring Saturdays - 4/18/26-5/23/26

Family Information
Parent/Guardian Name - 1*

First NameLast Name
Parent/Guardian Phone - 1*
Please enter a valid phone number.
Parent/Guardian Email - 1*
example@example.com
Parent/Guardian Name - 2

First NameLast Name
Parent/Guardian Phone - 2
Please enter a valid phone number.
Parent/Guardian Email - 2
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Language
Is your child fluent in English?*

YesNo
Do the parents/guardians speak in English?*

YesNoSome English
If "No" or "Some,", what languages so the students/family speak?

Emergency Contact Information
Does your child have health insurance?*

YesNo
If your child does have health insurance...
Please list any current medications, medical conditions, or recent injuries:
Please list any allergies, including food or medication allergies:
In case of emergency and the parent and or caregiver cannot be reached, please notify:
Emergency Contact 1
Emergency Contact 2
Emergency Treatment Release

I authorize Real Options for City Kids (R.O.C.K.) to furnish and/or obtain emergency medical treatment which may be necessary for my child during its programing. I also authorize Real Options for City Kids (R.O.C.K.) to arrange for transportation in case of accident or acute illness of the participant. In the event it is not possible to receive instruction for the participant’s care, consent is given to any licensed physician for treatment. I allow the physician to administer medication and to perform necessary treatment for the preservation of the participant’s health and well-being. I understand that any cost incurred for the treatment of sudden illness or accident shall be paid by me. This authorization and consent for treatment is given to R.O.C.K. in conjunction with any authorized event.
Do you agree with the Emergency Treatment Release statement above?*

YesNo
If you select NO, your student will not be able to participate in R.O.C.K.'s programs. It is important that we are able to treat your student immediately if they are injured during program, so for their safety we need a YES to this statement.

Please go back and select YES, or reach out to your Site Coordiantor if you have questions:
- El Dorado Elementary School: NeNe Harper at (415) 326-4182 or nene@rocksf.org
- Visitacion Valley Elementary School: Tristan Warmsley at (415) 763-1129 or tristan@rocksf.org

Dismissal/Sign Out
My child may (choose one):*

May go home alone (walk and/or bus)May get picked up (please list names below)
My child MAY get picked up by (list all names):
My child may NOT get picked up by (list all names):

Permissions
Media Release

We use photos, videos and stories to share R.O.C.K.’s mission with our donors and our community so that we can further our mission and continue to grow! We strongly encourage all parents/guardians to allow us to use photos to share with our partners.

"I hereby consent to the use of my child’s name, likeness and speech in any audio tape, video tape, film or photograph made in any R.O.C.K. activity for the business or publicity purposes of the R.O.C.K. and its partners. I understand that any participation offers no remuneration and that name, image and voice of my son/daughter may be edited, produced, recorded for duplication and distribution in the United States and abroad. I expressly release the R.O.C.K., its licensees, assignees, affiliates and successors from any privacy, defamation, or other claims have arising out of broadcast, exhibition, publication, or promotion of this program."
Do you agree with Media Release statement above?*

YesNo
General Release of Liability

In consideration for the being allowed participant privileges in any program of the R.O.C.K., I hereby assume full responsibility for any risk of bodily injury, death, or property damage and/or while using the premises or any facilities or equipment hereon. I further agree to hold harmless the ROCK, their partners, directors, officers, employees, agents, and volunteers from any and all claims that may result from any action for damages, including but not limited to such claims that may result from injury or death, accident or otherwise, during or arising in any way from said activity. I acknowledge that this General Release of Liability of the R.O.C.K. and its partners is binding on me and not my heirs, personal representatives, successors, and assigns.
Do you agree with the General Release of Liability statement above?*

YesNo
If you select NO, your student will not be able to participate in R.O.C.K.'s programs. It is required for participation in our programs.

Please go back and select YES, or reach out to your Site Coordiantor if you have questions:
- El Dorado Elementary School: NeNe Harper at (415) 326-4182 or nene@rocksf.org
- Visitacion Valley Elementary School: Tristan Warmsley at (415) 763-1129 or tristan@rocksf.org
Having full confidence that every precaution will be taken to ensure the safety and well-being of my child at R.O.C.K.’s Skill Drills, I agree to his/her participation.
Please sign to agree with the above statement.*

Clear

Payment

Fee: $5 for the entire session (6 Saturday).
How would you like to pay?

Cash - please give your cash to a R.O.C.K. staff memberCheck - please give your check to a R.O.C.K. staff memberCredit Card - you will be sent to R.O.C.K.'s program registration page to pay via credit card.

Thank you!
Credit Card Payment
When you submit this form, you will be taken to R.O.C.K.’s program registration page to pay via credit card. This platform will automatically add a processing fee and “tip” for the platform, but you can remove both. To remove the credit card fee click “edit” and then remove the check mark next to “Yes, cover the fees.” To remove the tip, select “other” and enter 0 for the tip. Please see the picture below.
Should be Empty:

Skill Drills Registration Form 2025-2026

Student Information

Family Information

Language

Emergency Contact Information

Dismissal/Sign Out

Permissions

Payment

Thank you!

Credit Card Payment