HoopsLab54 Presents One-Day Basketball Clinic Featuring NBA and NCAA Champion Antoine Walker

Sunday, July 26 | 12:30 pm - 3:00 pm
Sachs Recreation Center - Deerfield, IL

All hoopers will enjoy age-appropriate basketball skills training and competition breakouts, Q&A session, followed by autographs and photographs.

$95 per participant

_____________________________________________

Payment Options:

Zelle:
Email: hoopslab54@gmail.com
Account Name: Hoops Lab 54

Please include the hoopers name in the payment memo.

Credit Card Payment:

Click here to pay by credit card

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Additional Information

All hoopers to bring their own basketball and item for autograph.

Questions? Call or text 847-922-4402 or email hoopslab54@gmail.com.

Registration is not complete until payment has been received.

Participant's Full Name

First NameLast Name

Participant's Date of Birth

Date

Child's age

What grade is your child entering this fall?

Please select your child’s t-shirt size below:

Please list any allergies or medications we should be aware of:

Parent/Guardian Name

First NameLast Name

Parent/Guardian Email

example@example.com

Parent/Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Waiver of Liability, Assumption of Risk, Release, and Medical Authorization

WAIVER OF LIABILITY, ASSUMPTION OF RISK, RELEASE, AND MEDICAL AUTHORIZATION&#13;&#10;In consideration for participation, I release and hold harmless HoopsLab54 LLC, Horace Grant Jr., Horace Grant, all coaches, volunteers, guest instructors, sponsors, facility owners, facility operators, employees, contractors, agents, representatives, and affiliates from any and all claims, liabilities, damages, losses, expenses, injuries, illnesses, property damage, disability, or death arising from participation in the event to the fullest extent permitted by law.&#13;&#10;I certify that the participant is physically capable of participating in basketball activities and authorize emergency medical treatment if deemed necessary. I understand that I am responsible for any resulting medical expenses.&#13;&#10;I understand that participation in basketball activities, drills, competitions, training sessions, autograph sessions, and related activities involves inherent risks including falls, collisions, sprains, fractures, concussions, illness, disability, property damage, serious bodily injury, and death. I voluntarily assume all risks associated with participation.&#13;&#10;I understand that the released parties are not responsible for lost, stolen, or damaged personal property. This agreement shall be governed by the laws of the State of Illinois.&#13;&#10;&#13;&#10;Photography, Video, and Media Notice&#13;&#10;Photography, videography, audio recording, livestreaming, and other media capture may occur throughout this event. By registering for and participating in this event, the participant and parent/guardian acknowledge and agree that HoopsLab54 LLC, Horace Grant Jr., Horace Grant, event staff, sponsors, partners, and authorized media representatives may photograph, record, reproduce, publish, distribute, display, edit, and otherwise use the participant's name, image, likeness, voice, statements, and appearance for promotional, marketing, educational, website, social media, and other lawful business purposes without compensation, notification, or additional consent.&#13;&#10;&#13;&#10;By electronically signing this Registration, Waiver of Liability, Assumption of Risk, Medical Authorization, and Media Notice, I acknowledge and agree that:&#13;&#10;- I am the parent or legal guardian of the participant listed above.&#13;&#10;- I have read and understand this Registration, Waiver of Liability, Assumption of Risk, Medical Authorization, and Media Notice.&#13;&#10;- I understand that photography and video recording will occur during the event and consent to the use of my child's image, likeness, voice, photographs, and video recordings as described above.&#13;&#10;- I voluntarily agree to all terms and conditions on behalf of myself and my child.&#13;&#10;- The information provided during registration is accurate and complete to the best of my knowledge.curate and complete.

I have read and agree to the Registration, Waiver of Liability, Assumption of Risk, Medical Authorization, and Media Notice.

Parent/Guardian Signature (Required for Waiver)

Date and Time

Date

Hour MinutesAM/PM Option

Please note that registration is not complete until payment of $95 has been received via Zelle.

Zelle Payment Information
Email: hoopslab54@gmail.com
Account Name: Hoops Lab 54

Credit Card Payment:

Click here to pay by credit card

Questions? Please call or text 847-922-4402 or e-mail hoopslab54@gmail.com