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1
Athlete's Name* This field is required.Nombre Completo del Atleta
First Name
Last Name
2
Athlete's Grade* This field is required.Grado del Atleta
Please Select
Please Select
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
3
Athlete's Date of Birth* This field is required.Nacimiento del Atleta
Date
Year
Month
Day
4
Athlete's Experience* This field is required.Experiencia del Atleta
Please Select
Please Select
No Experience
Beginner
Intermediate
Advanced
School Team Experience
Travel Team Experience
5
Program's Interested In* This field is required.Programas Interesados
Skills Training
Travel Team
Private Training
Shooting Machine Training
Athletic Performance
Basketball Camps
6
Parent/Guardians Name* This field is required.Nombre Completo del Padre/Madre
First Name
Last Name
7
Parent/Guardian's Phone Number* This field is required.Número de Teléfono Principal
Please enter a valid phone number.
8
Parent/Guardian's Email* This field is required.Correo Electrónico Principal
example@example.com
9
Preferred Language* This field is required.Idioma Preferido
Please Select
Please Select
English
Spanish
10
Waiver/Release of Liability For Minor Participant's* This field is required.Please Read The Following Waiver Carefully 1) I acknowledge and fully understand that my child will be engaging in activities that involve risk of serious injury, which may include permanent disability and even death, and severe social and economic losses which might result not only from my child's actions, but also from the action, inaction, or negligence of others, the rules of play, or the condition of the premises, or any equipment used, and further that there may be risks not known to me or not reasonably foreseeable. I expressly assume all risks of injury, including death, which may occur in connection with my child's participation in any of the activities that take place at Vice City Basketball Academy, LLC. 2) I willingly agree to comply with the program's stated and customary terms and conditions for my child's participation. If I observe anything unusual or of significant concern in my child's readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention to the nearest official/supervisor immediately. 3) I release, waive, discharge, and agree not to sue Vice City Basketball Academy, LLC from all demands, losses, or damages on account of any bodily injury, death or property damage caused. Along with all its owners, directors, employees, volunteers, sponsors, sponsoring agencies, advertisers, and lessors of premises used to conduct the academy. BridgePrep Village Green: Located 13300 SW 120th St, Miami, FL 33186; Miami Coral Park Senior High School: Located 8865 16th St, Miami, FL 33165; Indoor Sports Miami: Located 8803 SW 132nd St, Miami, FL 33176 4) In case of a medical emergency I consent to have medical transportation called in order to obtain treatment in the event of an injury to my child during any Vice City Basketball Academy activity. This Release extends to any liability arising out of or in any way connected with the medical treatment and transportation provided in the event of an emergency. If the above-named child may require any emergency medical treatment or procedures during an activity, I hereby consent to authorize Vice City Basketball and its supervisor(s) to make the best decision. 5) Health: The child named above, is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems to one of our staff members. 6) Pictures/Videos For Social Media: I hereby grant Vice City Basketball Academy the irrevocable, worldwide, royalty-free right and license to photograph, record, and use the athlete’s image, likeness, voice, and performance in any media, including but not limited to photographs, videos, and digital recordings, for promotional, educational, and commercial purposes. I the guardian understands and agrees that such media content may be published on social media platforms, including YouTube, and that Vice City Basketball Academy may monetize such content. I the guardian hereby waive any rights to royalties or other compensation arising from or related to the use of such media by Vice City Basketball Academy. I the guardian further agrees that no third party shall have any claim or entitlement to profits or revenues generated from media content featuring the athlete created or distributed by the Vice City Basketball Academy. 7) Pick-Up/ Transportation: I the guardian understands that certain Vice City Basketball Academy staff or volunteers may provide transportation for the athlete to and from tournaments or related events. By signing this agreement, I the guardian grants permission for the athlete to be transported by authorized organization personnel. I the guardian releases the Vice City Basketball Academy from any liability arising from transportation, including but not limited to accidents, injuries, or other incidents occurring during transit, except in cases of gross negligence or willful misconduct. . 8) Mentoring: I authorize and give permission that my child may be offered mentoring, which is intended to help young athletes understand the principles of the Christian faith. I understand and consent that Christian principles and encouragement may be emphasized during my child's training and events. 9) Disclaimer: I understand that there will be NO makeup sessions due to bad weather, holidays, or missed attendance. I the guardian certifies that I have read this Agreement in its entirety, fully understand its terms, and voluntarily agree to be bound by it on behalf of themselves and the Athlete.
11
I have read and agree to the Waiver and Release of Liability for my child/minor participant.* This field is required.
YESNO
12
Guardian SignaturePlease sign below to acknowledge that you have read, understood, and agreed to all terms and conditions stated in this Guardian Waiver and Release Agreement on behalf of the minor participant.
13
Please verify that you are human* This field is required.
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