basketball

Parent / Guardian Name *

Parent / Guardian Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

I understand that my child must be dropped off at 5:00 pm *

Agree Disagree

I understand that my child must be picked-up by 7:00 pm or an additional fee may be applied *

Agree Disagree

I understand that my child must display positive behavior during camp or he/she will be dismissed after three strikes *

Agree Disagree

Student Name *

First

Last

Allergies/Special Accommodations *

Student Name 2 *

First

Last

Allergies/Special Accommodations *

Student Name 3 *

First

Last

Allergies/Special Accommodations *

Video Recording Consent: I am aware and I AGREE that the UAP may be recording sessions during the program. The UAP may be using these recordings to promote awareness of the program in presentations, flyers, brochures, and on the UAP websites and social media platforms. *

Photo Release Statement: I am aware that the UAP may be taking pictures during sessions of the program. The UAP may be using these photographs to promote awareness of the program in presentations, flyers, brochures, and on the UAP websites and social media platforms. Please indicate below whether you give permission to the UAP to photograph your child(ren). *

Release and Waiver Statement: I am leaving my child/children with the UAP basketball program. I forever release and discharge the UAP, all of their employees, all of their agents, all of their members and managers, and the staff of this program for any liability that may occur during my child's participation. I AGREE in consideration for my child's participation in all UAP services to the following: I AGREE to release the UAP from all claims for money damages. I AGREE to pay any losses, damages, or costs incurred and to hold the UAP harmless with respect to claims for harm to my child. I am a parent/guardian of a minor and I consent to the child's participation and AGREE to all of the provisions and AGREE to assume all of the obligations of this release on the child's behalf. I AGREE that the UAP as used above includes all of their officials, officers, directors, employees, agents, personnel, volunteers, staff and affiliated organizations. I further AGREE to be bound by all applicable UAP rules, terms and provisions of the organization. Please initial below. *

Payment: Filling out the form above completes the registration process. Please initial below. *

Signature: I verify that the above information is accurate and complete. I also have read and understood the video recording consent, release and waiver statement, and photo release statement. By typing in your name in the below field, you e-sign your signature to all of the above information. *

YOUR CART

Summer Youth Basketball Training Program and League

A 6-Week Program

We are Social

Contact Us

Our Location

YOUR CART

​Summer Youth Basketball Training Program and LeagueA 6-Week Program

We are Social

Contact Us

Our Location

Summer Youth Basketball Training Program and League

A 6-Week Program