test page - Factory Basketball Academy

Company

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Child Information

Child's Name(Required)

First Last

Age(Required)

Date of Birth(Required)

This is the my child's first time in the Factory House League Program(Required)

Shirt Size(Required)

Sizing Information:

Intro to Basketball shirt sizes are YOUTH sizes. Adult sizing is available by request.

Preferred Jersey Number 1(Required)

Preferred Jersey Number 2(Required)

Preferred Jersey Number 3(Required)

Allergy | Medical Information(Required)

Programs

Intro to Basketball

Intro to basketball is one of the Factory Basketball Academy’s most popular programs for the engagement the players receive and the positive experience they take from it. 4-5 year old players and 6-8 year old players will learn how to dribble, pass and shoot. (We highly recommend the age appropriate basketball) classes end with games such as “octopus” or tag.

4-5 Years: $85.00

6-8 Years: $85.00

4-5 years: Mondays
Location:St. George German School - 3 College Street - St. George
Time: 6:00pm - 6:30pm
Dates: 6 Weeks May 11th - June 22nd

6-8 years: Mondays
Location: St. George German School - 3 College Street - St. George
Time: 6:30pm - 7:00pm
Dates: 6 Weeks May 11th - June 22nd

Parent / Guardian Information

Parent / Guardian Name(Required)

First Last

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Emergency Contact(Required)

First Last

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Disclaimer

Request for permission: I, the above referenced youth athlete’s parent/guardian, hereby register my child to participate in Factory Basketball activities.

Assumption of risk: I acknowledge and understand that there is a risk of injury involved in athletic participation. I understand that my child will be under the supervision and direction of a volunteer or coach. I agree to follow the rules for the sport and the instructions of the coach in order to reduce the risk of injury to my child and other athletes. However, I acknowledge and understand that neither the volunteer coach nor the organization can eliminate the risk of injury in sports. Injuries may and do occur. Sports injuries can be severe and in some cases may result in permanent disability or even death. I freely, knowingly and willfully accept and assume the risk of injury that might occur from my child’s participation.

Release: In consideration of allowing my child to participate in the above basketball program, I hereby agree to release, wave, discharge, covenant not to sue, hold harmless, and indemnify, on behalf of myself and any other parent or guardian of my child, The Factory Basketball Academy and their respective volunteer youth, coaches, officials, agents, employees, directors, members, officers and other staff members from liability to us and our child as well as our personal representatives, assigns, heirs and next of kin, for any, and all claims, suits, or causes of action arising from or out of any injury, known or unknown, to property or body, that my child may suffer from participation in athletics, activities, or the above – described sports activities.

Photographs: Photographs will occasionally be taken of the children during the sports activities. By signing this registration form, I consent to the use of pictures of my child for displays, brochures, and promotion materials with no compensation to me or my child.

Medical: I, the undersigned, hereby certify to the best of my knowledge, my child is physically able to safely participate in the sports activity for which he or she has been registered. In addition, I understand that in the case of the illness or injury of my child officials from The Factory Basketball Academy will try to notify me or the emergency contact listed on this form. In the event of medical emergency concerning my child at a time when either I or the emergency contact person cannot be notified, I hereby authorize officials or my child’s coach to obtain the necessary medical care and/or treatment for my child, including but not limited to, first aid, x-ray examinations, and medical or hospital care and I hereby accept the sole financial responsibility for such medical care, first aid, or treatment.

Parent / Guardian Name - By typing my name I acknowledge and accept the above conditions as outlined in the disclaimer.(Required)

Please Type Your Name to Confirm.

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