Athlete Training - Monthly Membership Registration Form

Athlete Training - Monthly Membership Registration Form
PRICING
• Monthly membership (6 sessions): $360/month
• Sessions must be used within the month - No Refunds
• No walk-ins without registration approval

SESSION RULES
• All athletes must be registered before participating
• Group sizes are capped
• Attendance tracked every session
Name of Child*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
Grade*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Full Name*

First NameLast Name
Contact Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Training Dates (1 Hour Sessions)*

Mondays 4:00 - 5:00 PMMondays 5:00 - 6:00 PMTuesdays 4:00 - 5:00 PMTuesdays 5:00 - 6:00 PMWednesdays 4:00 - 5:00 PMWednesdays 5:00 - 6:00 PMFridays 4:00 - 5:00 PMFridays 5:00 - 6:00 PMSaturdays 7:30 - 8:30 PMSaturdays 8:30 - 9:30 PMSundays 7:00 - 8:00 PMSundays 8:00 - 9:00 PM
Start Date: *

MonthDayYear
Date
Waiver: I acknowledge, appreciate, and agree that: 1) The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 2) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3) I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the Releasees, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event ("RELEASEES"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. MEDIA RELEASE: I agree and give consent for the King Nation Basketball organization and/or partners to record, film, photograph, audiotape or videotape my child's name, image, and performance and consent to use for advertising, promotional or commercial purposes of any kind at the sole discretion of King Nation Basketball including, but not limited to, the King Nation Basketball website and all social media platforms. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.*

I/We agree with above

My Subscriptions*

Monthly Membership6 Sessions per month

$360.00CAD for each month

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Signature*

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Date*

MonthDayYear
Date
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