CKP Pass It Forward - November Registration Form

Pass It Forward: Basketball + Life Skills Clinic

Please fill out the registration information below
Athlete Information
Athlete Full Name*

First NameLast Name
Grade*
School*
T-Shirt Size
Parent / Guardian Information
Parent Name*

First NameLast Name
E-mail*
example@example.com
Cell Number*
Please enter a valid phone number.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship to Athlete*
Phone Number*
Please enter a valid phone number.
Does the athlete have any allergies, chronic illness, or medical condition? If yes, please describe.*
Waiver of Release & Liability

By checking this box and signing below, I acknowledge that participation in the CKP Athletics Clinics involves physical activity and inherent risks of injury. I voluntarily assume all risks on behalf of myself/my child.

I hereby release and hold harmless CKP Athletics Foundation, CKP Athletics LLC, Shoot360 DSM, its sponsors, coaches, volunteers, and staff from any liability for injury, illness, or damages arising from participation.

I also authorize emergency medical care if necessary and acknowledge that I/my child are responsible for any related expenses. I grant permission for photos/videos of me/my child to be used for promotional purposes.
I have read and fully understand the Waiver & Release of Liability above, and I agree to its terms on behalf of myself/my child.
Signature

Clear
Date

MonthDayYear
Date
Clinic Selection
Please Note:
** Lunch Provided: A meal will be included for all participants. If your child has food allergies or prefers specific foods, please send a packed lunch with them on the day of camp. **
Which Session Are you Registering For?*

Friday, Nov. 28th: 10am-2pm (High School)Saturday, Nov. 29th: 10am-2pm (6th-8th Graders)Sunday, Nov. 30th: 10am-2pm (4th & 5th Graders)
I would like to apply for a scholarship (Limited availability)

Yes
Scholarship Application

(Note: All scholarship requests are confidential. If selected, you’ll receive a confirmation email with next steps. Limited spots available.)
Why would this scholarship help you?
Do you currently participate in free/reduced lunch?

YesNo
Anything else you’d like us to know?
Payments
Use coupon code EARLYBIRD for $25 off the standard registration fee. Valid through Oct. 24th.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Enter coupon

Pass It Forward: Basketball + Life Skills Clinic

Athlete Information

Parent / Guardian Information

Emergency Information

Clinic Selection

Scholarship Application

Payments