GB Ballers Basketball Training Session

Choose a session date:

*Beginning April 2026, sessions will be held at Southern Pines Parks & Rec/ Boys & Girls Club of the Sandhills (160 Memorial Park Ct, Southern Pines)

Athlete Information

Athlete's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent/Guardian Information

Name

First NameLast Name

Home Number

Area CodeNumber

Cell Number

Area Code Number

E-mail

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area Code Number

Alt. Phone Number

Area CodeNumber

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Voluntary Participation
I understand that my child’s participation in the basketball training program operated by Coach Germann Bostic/GB Ballers Inc. is voluntary. I acknowledge that basketball training involves physical activity that may include running, jumping, drills, contact, conditioning, and other athletic movements.

Assumption of Risk
I understand that participation in basketball training carries inherent risks, including but not limited to muscle strains, sprains, bruises, fractures, dehydration, or other injuries. I knowingly and willingly assume all risks associated with my child’s participation, whether caused by the actions of my child, other participants, coaches, or conditions of the facility.

Medical Clearance & Health Information
I affirm that my child is physically capable of participating in athletic training and has no medical conditions that would prevent safe participation, or that any medical conditions have been disclosed in the registration form above.

I understand it is my responsibility to notify the coach of any changes to my child’s health.

Emergency Medical Treatment Authorization
In the event of an emergency, I authorize Coach Germann Bostic and/or program staff to obtain medical treatment for my child if I cannot be reached. I understand that I am financially responsible for any medical care provided.

Release of Liability & Hold Harmless Agreement
I hereby release, waive, discharge, and hold harmless Coach Germann Bostic, GB Ballers Inc. Basketball Training, affiliated staff, volunteers, facilities, and sponsors from any and all claims, demands, or causes of action arising out of or related to participation in this program, including any injury or loss, whether caused by negligence or otherwise, to the fullest extent permitted by law.

Code of Conduct Acknowledgement
I understand that participants are expected to follow all program rules, demonstrate sportsmanship, respect coaches and teammates, and behave appropriately. I acknowledge that failure to comply may result in removal from training without refund.

Photo & Video Release
I grant permission for photographs or video recordings of my child taken during training to be used for promotional, educational, or marketing purposes related to GB Ballers Inc. basketball training, without compensation.

Payment & Refund Policy Acknowledgement
I understand that training fees are non-refundable unless otherwise stated by the program. Missed sessions are not guaranteed makeup opportunities.

Medical Release and Authorization

As the parent and/or legal guardian of the named athlete, I authorize evaluation, diagnosis, and treatment by a qualified and licensed medical professional in the event of a medical emergency. This authorization applies when, in the judgment of the attending medical professional, immediate care is necessary to prevent serious harm, including risk to life, physical disfigurement, physical impairment, or unnecessary pain, suffering, or discomfort due to delay.

I grant permission to the attending physician to provide medical care deemed necessary, including minor surgical treatment, X-ray examinations, and immunizations for the named athlete. In the event of a serious illness, significant injury, or the need for major medical intervention, every reasonable effort will be made to contact me as quickly as possible. This authorization applies only after reasonable attempts to reach me have been made.

I also grant permission to Germann Bostic, GB Ballers Inc. and its affiliates, including directors, coaches, staff, and team parents, to administer or obtain emergency care for my child prior to or during transport to a medical facility when immediate action is required.

This authorization is valid for the dates and duration of the registered season.

This medical release is given voluntarily and is executed for the sole purpose of authorizing emergency medical treatment for the protection of the health, safety, and well-being of the named minor child in my absence.

Confirmation

By completing this form, I confirm that I have read and understand this Informed Consent and Acknowledgement to Participate and agree to its terms. 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.

E-Signature

Payment Option

**$40 PAYMENT IS DUE IMMEDIATELY AFTER SIGNING UP BY METHOD SELECTED ABOVE!**