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Play Like a Girl Basketball Clinic Thursday, July 23, 10am -1pm SOUTH SIDE YMCA 6330 S Stony Island Ave
PLEASE NOTE VENUE CHANGE!!
Participant's Full Name
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First Name
Last Name
Participant's Date of Birth
*
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Month
-
Day
Year
Date
RISING GRADE
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does the participant have any allergies or medical conditions? If yes, please list.
1. Assumption of Risk: I understand and acknowledge that participation in sports, clinics, and related physical activities involves inherent risks, including but not limited to severe bodily injury, permanent disability, paralysis, and death. I voluntarily and knowingly assume all such risks associated with participation in this sports clinic. 2. Release and Waiver of Liability In consideration of being permitted to participate in this clinic, I hereby release, waive, discharge, and covenant not to sue [Insert Organization Name], its owners, directors, officers, employees, coaches, and volunteers (collectively, the "Releasees") from any and all liability, claims, or demands for personal injury, sickness, or property damage of any kind arising out of my (or my child's) participation in this clinic, even if caused by the negligence of the Releasees. 3. Medical Treatment Authorization In the event of an injury or medical emergency, I hereby grant permission to the clinic staff and medical professionals to administer necessary first aid or authorize emergency medical treatment. I understand and agree that I will be financially responsible for any and all medical costs, hospital expenses, or ambulance fees incurred as a result of such treatment. 4. Photo and Video Release I hereby grant SERVCOM, INC the absolute and irrevocable right to use my (or my child's) image, likeness, or voice in photographs, video, or audio recordings for promotional, marketing, or educational purposes across print, digital, and social media platforms.
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Parent/Guardian Signature
*
Register
Register
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