Free Practice Form

1
Child's Name* This field is required.
First Name
Last Name
2
Child's Age* This field is required.
Please Select
Please Select
9 Years Old
10 Years Old
11 Years Old
12 Years Old
13 Years Old
14 Years Old
15 Years Old
16 Years Old
17 Years Old
3
Child's Grade* This field is required.
Please Select
Please Select
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
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Child's Gender* This field is required.We Are A Boys Only Basketball Program.
Male
5
Parent/Guardian's Name* This field is required.
First Name
Last Name
6
Phone Number* This field is required.
7
E-mail* This field is required.
example@example.com
8
Location of Choice* This field is required.
Please Select
Please Select
West Kendall: 12601 SW 72nd St, Miami, FL 33183
Doral: 3508 NW 114th Ave, Doral, FL 33178
9
Waiver/Release of Liability For Minor Participants 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 childs 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 childs 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 childs participation. If I observe anything unusual or of significant concern in my childs 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 immediatly. 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. Alonso Ministries, Inc (DBA RiseUp Outreach) and CER, LLC: Located 12601 SW 72nd St, Miami, FL 33183 Church; Miami Sports Box, LLC: Located 3508 NW 114th Ave, Miami, FL 33178; Miami Killian Senior High School: Located 10655 SW 97th Ave, 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 give the right for Vice City Basketball Academy to take pictures and videos during any of my child's participation in the academy. I consent to allow all images and videos to be used by Vice City Basketball Academy for their business discretion. 7) Pick-Up/ Transportation: Parents/Guardians are responsible for securing their child's transportation to and from Vice City Basketball Academy locations. It is the parents/guardians responsibility to make sure their child is dropped off on time before practice and picked up on time after their practice. Coaches and staff members will not be responsible to supervise your child before or after practice. 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. By completing and submitting this registration you are acknowledging that you are agreeing to all of these terms and conditions.
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I acknowledge that my child may be spoken about FAITH based teachings to build character and leadership skills.During Vice City Basketball Events There May Be Teachings On Biblical Principles and Jesus.
YESNO
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Please Verify That You Are Human* This field is required.
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