November Basketball Classes

November Basketball Classes Registration Form

November 7, 14, 21, 28
Participant Information
Parent/Guardian Full Name

First NameLast Name
Parent's Email Address
example@example.com
Parent's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What city do you live in?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child's Full Name

First NameLast Name
Child's Date Of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child's Age At Start Of Program
Child's Skill Level
How Did You Hear About Us?

Participation & Consent
The Participant and/or Participant's Parent(s) and/or Guardian(s) is also fully aware and understands that such losses, injury, disability or death may result from the actions, inactions or negligence on the part of the Participant, on the part of North County Sports Academy LLC, on the part of others, the rules of play or the condition of the Premises and/or equipment.
I am the participant’s parent or legal guardian and authorize participation in North County Sports Academy LLC (“NCSA”) programs. NCSA includes its owners, employees, independent contractors, agents, representatives, and volunteers. Activities include lessons, classes, camps, evaluations, organized activities, and use of training premises and equipment, including activities at other locations and associated travel.

Risks and responsibilities. Sports and physical activity involve risks, including being struck by balls, bats, or other equipment; collisions; falls; strenuous exertion; illness; property loss; and minor or serious injury, permanent disability, or death. These risks may arise from participants, other people, premises, equipment, or NCSA’s acts or omissions, including ordinary negligence. I understand these risks and voluntarily accept them to the extent permitted by California law. I will disclose relevant health concerns, follow safety instructions, report unsafe conditions, and obtain instruction before unfamiliar equipment is used. I understand that on-site medical services may not be available.

Release and indemnity. To the fullest extent permitted by California law, I release NCSA from claims arising from participation or use of premises or equipment, including injury, illness, death, and property loss caused by ordinary negligence. I agree not to sue on those released claims. I agree to indemnify and hold NCSA harmless from claims arising from participation, to the extent legally enforceable. This agreement does not release liability that cannot lawfully be released.

Understanding and governing law. I have read this agreement, understand that it gives up substantial rights, and sign voluntarily. California law governs. Any action must be brought in California, subject to applicable law. If a provision is unenforceable, the remaining provisions continue to the extent permitted by law.
Photo & Media Release
Photo & Media Release:
If I select authorization below, I permit NCSA to photograph or record my child during programs and use the resulting media without compensation in public promotional, educational, or informational materials, including websites, social media, print, and advertising. I waive approval of the finished use. If I select no authorization, I do not permit promotional photography or recording of my child.
The specific risks involved with the activities conducted in, on or about the Premises vary from one activity to another, but in each activity the risks range from (1) minor injuries such as scratches, bruises and/or sprains to (2) major injuries such as loss of sight, broken bones, joint, ligament, cartilage, back injuries, concussions, and/or heart attacks to (3) catastrophic injuries including but not limited to illness, infection, paralysis, and/or death.
The Participant and/or Participant's Parent(s) and/or Guardian(s) is/are fully aware and understand that North County Sports Academy LLC does not have in, on or about the Premises, or employ or contract with, any medical services, or provisions for ordinary or emergency medical services including but not limited to emergency cardiovascular assistance.
Please Explain:
The Participant and/or Participant's Parent(s) and/or Guardian(s) agrees that immediately prior to participating in any activity occurring in on or about the Premises he/she/they will inspect the Premises and equipment to be used and if any defect is apparent, the Participant will not use the Premises and/or equipment and will notify North County Sports Academy LLC of the defect.
The Participant and/or Participant's Parent(s) and/or Guardian(s) further agrees that if he/she/they is not knowledgeable in the proper use of any equipment, he/she/they will obtain proper instruction for the correct use of such Premises and/or equipment from North County Sports Academy LLC and/or a qualified individual before the Participant uses the Premises and/or equipment.
The Participant and/or Participant's Parent(s) and/or Guardian(s) further agrees that he/she/they indemnify and hold harmless North County Sports Academy LLC for any and all claims arising from the Participant's involvement in receiving instruction for or related to North County Sports Academy LLC and activities incidental thereto wherever, whenever, and however the claims may arise including but not limited to travel to and, North County Sports Academy LLC's Premises or related activity site and participation at remote sites.
The Participant and/or Participant's Parent(s) and/or Guardian(s) assumes all of the foregoing risks and accept personal responsibility for any damages following any loss of property, injury, permanent disability or death resulting therefrom.
Waiver: In consideration of permission to use North County Sports Academy LLC's equipment, the Premises, and services, the undersigned Participant and/or Participant's Parent(s) and/or Guardian(s), on behalf of himself/herself, family, estate, heirs and assigns, do hereby release, waive, and covenant not to sue North County Sports Academy LLC, and discharge liability from any and all claims arising or resulting from the use of the Premises and/or equipment on the Premises or otherwise used or operated by North County Sports Academy LLC. This agreement applies to (1) personal injury (including death), damage, or liability from accidents or illnesses arising from participation in North County Sports Academy LLC's activities including, but not limited to: lessons, clinics, camps, classes, evaluations, observations, organized activities, and individual use of Premises and/or equipment, and to (2) any damage to, loss of, or theft of property.
Acknowledgement of Understanding: The undersigned Participant and/or Participant's Parent(s) and/or Guardian(s) have read this Waiver Release of Liability and Assumption of the Risks (herein referred to as the "Waiver") and fully understands its terms. The undersigned Participant and/or Participant's Parent(s) and/or Guardian(s) (1) knows and understands the nature of the activities conducted at the Premises, (2) knows and understands the demands of those activities relative to the Participant's physical condition and skill level, and (3) understands the types of injuries which may occur as a result of participation in the activities conducted in, on or about the Premises. The undersigned Participant and/or Participant's Parent(s) and/or Guardian(s) hereby assert that participation is voluntary and that the undersigned Participant and/or Participant's Parent(s) and/or Guardian(s) knowingly assumes all such risks. The undersigned Participant and/or Participant's Parent(s) and/or Guardian(s) acknowledge freely and voluntarily sign the Waiver and intend their signatures to signify a complete assumption of the inherent risks of participating in or observing recreational activities at the Premises to the greatest extent allowed by law in the State of California. In signing the Waiver as Parent(s) and/or Guardian(s), you acknowledge that you are consenting to the Participant's participation in the activities conducted at the Premises and acknowledge, both on behalf of Participant and/or the Participant's Parent(s) and/or Guardian(s), that Participant and/or Participant's Parent(s) and/or Guardian(s) expressly assume all inherent risks of the activity. The undersigned Participant and/or Participant's Parent(s) and/or Guardian(s) have read the Waiver and fully understand its terms. The undersigned understands that the Participant and/or Participant's Parent(s) and/or Guardian(s) are giving up substantial rights, including the right to compensation for injury resulting from ordinary negligence. The undersigned Participant and/or Participant's Parent(s) and/or Guardian(s) acknowledges that he/she/they is signing the agreement freely and voluntarily, and intend his/her/their signature to be a complete and unconditional release of liability and waiver of liability to the greatest extent allowed by law in the State of California. In signing the Waiver as Parent(s) and/or Guardian(s), you acknowledge that you are consenting to the Participant's participation with North County Sports Academy LLC and acknowledge that you understand that any and all risks, including that of ordinary negligence, whether known or unknown, are expressly assumed by the Participant and/or Participant's Parent(s) and/or Guardian(s) and all claims, whether known or unknown, are expressly waived in advance.
Severability, Venue, and Governing Law:
The undersigned Participant and/or Participant's Parent(s) and/or Guardian(s) further expressly agree that the Waiver shall be governed by and construed in accordance with the laws of the State of California without giving effects to its rules regarding conflicts of laws and is intended to be as broad and inclusive as is permitted by the law of the State of California. If any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Likewise, the undersigned Participant and/or Participant's Parent(s) and/or Guardian(s) agree that if legal action is brought, it must be brought in the State of California.
Coronavirus/COVID-19:
The undersigning Participant and/or Participant's Parent(s) and/or Guardian(s) acknowledges the contagious nature of the Coronavirus/COVID-19 and that the Centers for Disease Control and Prevention (CDC) and many other public health authorities still recommend practicing in social distancing. The undersigning Participant and/or Participant's Parent(s) and/or Guardian(s) further acknowledge that North County Sports Academy LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19, including but not limited to, wearing a facial mask/covering and hand sanitizing frequently. The undersigning Participant and/or Participant's Parent(s) and/or Guardian(s) further acknowledge that North County Sports Academy LLC cannot guarantee that the Participant and/or Participant's Parent(s) and/or Guardian(s) will not become infected with the Coronavirus/COVID-19. The undersigning Participant and/or Participant's Parent(s) and/or Guardian(s) understands that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of the Participant and/or Participant's Parent(s) and/or Guardian(s) and others, including, but not limited to, North County Sports Academy LLC and other Participants and/or Participant's Parents(s) and/or Guardian(s). The undersigning Participant and/or Participant's Parent(s) and/or Guardian(s) voluntarily seeks services provided by North County Sports Academy LLC and acknowledge that he/she/they is/are increasing his/her/their risk of exposure to the Coronavirus/COVID-19. The undersigning Participant and/or Participant's Parent(s) and/or Guardian(s) acknowledges that he/she/they must comply with all set procedures by the Centers for Disease Control and Prevention (CDC) and/or North County Sports Academy LLC to reduce the spread while participating in any activities provided by North County Sports Academy LLC.
Photo & Media Release:
I hereby grant North County Sports Academy (NCSA) permission to take photographs, video recordings, and other media of myself/my child during participation in NCSA programs, events, or activities. I authorize NCSA to use such media, without compensation, for promotional, educational, or informational purposes including (but not limited to) websites, social media, printed materials, and advertisements. I understand that these images may be used in various media formats and distributed to the public. I waive any right to inspect or approve the finished product or any use to which it may be applied. If I do not wish for myself/my child to be photographed or recorded, I will notify NCSA in writing prior to participation.
Parent/Guardian Full Name
Photo and Media Permission
Child's Full Name
Parent or Guardian's Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Medical Authorization and Emergency Consent Form
Participant Information
Child's Full Name
Date of Birth:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Full Name
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Emergency Contact
Name:
Relationship to Participant:
Phone Number:
Format: (000) 000-0000.
Medical Information
Does your child have any allergies, medical conditions, injuries, or other health concerns that NCSA staff should be aware of?
Please Explain:
Is your child currently taking any medications?
Emergency Medical Authorization
If my child becomes ill, is injured, or has a medical emergency during NCSA activities, I authorize staff to call emergency services, provide first aid within their training, and obtain emergency treatment if I cannot be reached. NCSA will make reasonable efforts to contact me promptly. I certify that the information provided is accurate and accept responsibility for my child’s medical expenses.
Parent/Guardian Acknowledgment
I certify that the information provided on this form is accurate to the best of my knowledge.I understand that participation in sports and recreational activities involves inherent risks of injury.I accept responsibility for any medical expenses incurred on behalf of my child.
Parent/Guardian Full Name
Child's Full Name
Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Concussion Information and Acknowledgment Form
Purpose
This form confirms that parents/guardians and participants have received information regarding concussion risks and understand the procedures used by North County Sports Academy, LLC ("NCSA").
What is a Concussion?
A concussion is a brain injury caused by a bump, blow, or jolt to the head or body that can change how the brain functions. Symptoms may appear immediately or develop over time.
Common Symptoms Include:
- Headache
- Dizziness
- Confusion
- Nausea
- Blurred vision
- Sensitivity to light or noise
- Balance problems
- Memory difficulty
Important Safety Rule
If a concussion is suspected:
The participant will be immediately removed from activity and will not return the same day.
Return-to-Play Requirements
A participant may return only when:
- Symptoms have fully resolved
- Medical clearance is obtained if required
- NCSA return-to-play protocol is followed
Risks of Continuing Activity
Continuing to participate after a concussion can result in:
- Worsening brain injury
- Prolonged recovery
- Increased risk of serious complications
Acknowledgment
I acknowledge that:
- I have read and understand the concussion information above
- I understand the risks of concussion in sports activities
- I agree to follow NCSA concussion safety procedures
- I agree that my child will not return to activity the same day if a concussion is suspected
Parent/Guardian Name:
Child's Full Name
Signature:
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Payment
Choose full-month registration or select the number of classes your child will attend.
prevnext( X )
Class Package

$99.00 Registration Option
Should be Empty:

November Basketball Classes Registration Form

Participant Information

Participation & Consent

Photo & Media Release

Severability, Venue, and Governing Law:

Coronavirus/COVID-19:

Photo & Media Release:

Medical Authorization and Emergency Consent Form

Participant Information

Emergency Contact

Medical Information

Emergency Medical Authorization

Parent/Guardian Acknowledgment

Concussion Information and Acknowledgment Form

Purpose

What is a Concussion?

Common Symptoms Include:

Important Safety Rule

Return-to-Play Requirements

Risks of Continuing Activity

Acknowledgment

Payment

Choose full-month registration or select the number of classes your child will attend.*

Choose full-month registration or select the number of classes your child will attend.