2020 Hoops All-Stars Registration Form

www.hoopsallstars.com

Participant Information

First Name *

Last Name *

Gender *

Birth Date * 🛈 +

Address 1 *

Address 2

City *

Prov. *

Postal Code *

Health Card Number (no dashes or spaces) * 🛈

Other Info Coaches Should Know (i.e. Medical Conditions)

Parent/Guardian Information

First Name *

Last Name *

Relationship *

Primary Phone *

Alternate Phone

Email Address *

Confirm Email *

Secondary/Emergency Contact Information (other than person above)

First Name *

Last Name *

Relationship *

Primary Phone *

Alternate Phone

Pick Up Authorization

Camper may leave on their own (only available for participant age 10 and over) *

Unless authorized at time or registration (for campers age 10 and over)

Campers MUST be picked up by authorized person. ID required for pickup

I understand and agree to pick-up policy (initials required) *

Person 1 - Full Name *

Relationship *

Person 2 - Full Name

Relationship

Person 3 - Full Name

Relationship

Select Weeks

Select Camp Location * 🛈

To ensure spaces are fairly distributed maximum of 3 weeks per participant is permitted.

Weeks: *

Waiting List

If your preferred week is full please send an email to registration@hoopsallstars.com requesting to be added to the waiting list.

Please indicate location & week requested in your email.

Liability Waiver

In consideration to participate in any capacity with the Hoops All-Stars program and any and all related events and activities, the undersigned, as authorized signatory, in his or her capacity as Parent or Guardian, on behalf of the Participant, acknowledges, appreciates and agrees that:

Risk of Injury

1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of such serious injury exists; and,

Assumption of Risks

2. I, the undersigned as authorized signatory, in my capacity as Parent or Guardian, on behalf of the Participant, knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of Hoops All-Stars, referees, volunteers, agents and/or employees, other players or participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the Hoops All-Stars program and any and all related events and/or activities (the \"Releasees\"), and assume full responsibility for the participation of the Participant; and,

3. I, the undersigned as authorized signatory, in my capacity as Parent or Guardian, on behalf of the Participant, willingly agree to comply with the stated and customary terms and conditions for participation. If, however, there is any unusual and/or significant hazard during my presence or during the participation of the Participant, I will remove the Participant from participation and bring such incident to the attention of the nearest official immediately; and,

Waiver of Liability

4. I, the undersigned as authorized signatory, in my capacity as Parent or Guardian, on behalf of the Participant, for myself and on behalf of the Participant and on behalf of our heirs, assigns, personal representatives and next of kin, hereby release and hold harmless the Releasees, with respect to any and all injury, disability, death, or loss or damage to person or property, whether caused by the negligence of the Releasees or otherwise.

Waiver of Multimedia Rights

5. I, the undersigned as authorized signatory, in my capacity as Parent or Guardian, on behalf of the Participant further agree to irrevocably grant Hoops All-Stars, the perpetual unlimited world-wide and royalty free rights to record, reproduce, broadcast, exhibit, publish, sell, distribute or use in any way whatsoever, the Participant’s name and likeness in any media, whether now known or hereafter developed, in connection with the Participant’s attendance and participation in the Hoops All-Stars program, including without limitation a videotape recording of such performance. I agree that we shall have no claim, title or interest in the Participant’s attendance or participation or any materials produced hereunder.

I agree to the above Liability Wavier Conditions (Initials Required) *

Date of Agreement * +