Exit Registration Form - Blazers Summer 2022 Shooting Program Blazers Summer 2022 Shooting Program Registration NOTE: For those signing up after the June 20th Video Session, you may join the summerlong program and attend an extra (7th) weekly session. We will perform the video analysis at the first Wednesday session that you attend. A few of the questions below are defaulted (have 2 of the same answers) to reflect this). Question Title * 1. Participant Information:Please provide just the informal names of participants/parents so the coaches will have that, and please use BOTH upper and lower case as appropriate (ensuring CAPS LOCK is off). For example, if the participant goes by Chris, please type Chris and not Christopher. First Name: * Last Name: * DOB (MM/DD/YYYY): * Allergies or other Physical/Medical Concerns: Medical Insurance: * Policy #: * Question Title * 2. What grade WILL the participant be in as of Sept 2022 (NOT THEIR CURRENT GRADE)? 03rd 04th 05th 06th 07th 08th 09th 10th 11th 12th Other (please specify) Question Title * 3. Gender of Participant: Male Female Question Title * 4. The Participant lives in what town? Ashland Bellingham Framingham Grafton Holliston Hopedale Hopkinton Hudson Marlborough Medway Milford Natick Northborough Sherborn Shrewsbury Southborough Sudbury Upton Wellesley Westborough Other (please specify) Question Title * 5. Which option are you registering for? Summerlong Program Summerlong Program Question Title * 6. Which instruction / video analysis session would you like to attend? I will participate in the video analysis during one of the Wednesday sessions I will participate in the video analysis during one of the Wednesday sessions Question Title * 7. Parent1 Information First Name: * Last Name: * Address: * Address 2: City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Cell Phone: * Email Address: * Question Title * 8. Parent2 or Other Emergency Contact First Name: Last Name: Cell Phone: Email Address: Question Title * 9. General Terms and Conditions:General Terms:As the parent or legal guardian of the player/child named above, I hereby give my full consent and approval for my child to participate in this program. I understand that there are certain risks of injury inherent in the practice and play of this sport, and I am willing to assume these risks on behalf of my child. I hereby certify that my child is fully capable of participating in the designated sport and that my child is healthy and has no physical or developmental disabilities or infirmities that would restrict full participation in these activities, except as listed above. I acknowledge that it is my responsibility to be knowledgeable about concussions in youth sports (CDC has a free course at https://www.cdc.gov/HeadsUp/index.html), and that Alpha Youth Sports has provided me with a link to concussion-awareness education material. If my child has any concussion like symptoms or has sustained a head injury, I agree to visit a licensed health care professional for evaluation, and to not allow my child to participate again until cleared by the licensed professional. I understand that my medical insurance is expected to cover the cost of my child’s injuries. I grant permission to the coaches or volunteers involved with this program to seek medical care for my child in the event I cannot be reached. I agree not to hold Alpha Youth Sports, or any of the parties/facilities connected with this program, responsible for any injury or accident that may occur to my child (or anyone accompanying them) during the program, whether the result of negligence or any other cause.Video Release: For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby consent to the photographing of my child and the recording of my child's voice by Alpha Youth Sports, Inc. (“AYS”) during this Program. I understand that the term "photograph" as used herein encompasses both still photographs and motion picture footage. Provided that AYS does not identify my child's last name, nor town of residence, in these photographs or recordings, I irrevocably consent to the use of these photographs and/or recordings singularly or in conjunction with other photographs and/or recordings for advertising, publicity, commercial or other business purposes, as well as to the reproduction and/or authorization by AYS to reproduce and use said photographs and recordings of my child's voice, for use in all domestic and foreign markets. I hereby release AYS, and any of its associated or affiliated companies, their directors, officers, agents, employees and customers, and appointed advertising agencies or other assigned third parties, their directors, officers, agents and employees from all claims of every kind on account of such use. Other Terms: - All program fees are non-refundable- I agree to familiarize myself and my child with the rules associated with the facilities used in this Program, including their usage, behavior and other rules that apply to the player and the parents, siblings, and others that accompany the player- I understand that if my child, or anyone accompanying them to a practice, game, or other event violates a facility rule, becomes a discipline problem, is unwilling to abide by the Program's rules/procedures, or is in any way risking the safety of (or negatively impacting the experience of) the other players in the program, my child may be dismissed from the Program, and that no money will be refundedDo you acknowledge your understanding and acceptance of these Terms and Conditions? Yes Question Title * 10. Supplemental Terms and Conditions associated with Pandemics and other Force Majeure Events:I acknowledge that COVID-19 infections have been confirmed throughout the United States. I agree that I will not permit the player named above or any other person (including me) to participate in any AYS event if he or she: (i) experiences symptoms of COVID-19; or (ii) has a suspected or diagnosed/confirmed case of COVID-19. I further agree to immediately notify AYS via email if the player, a member of their family unit, or anyone else that they have come in close contact with tests positive for COVID-19.I agree that the player and anyone else (including me) that accompanies the player to any AYS event will comply with and submit to any and all policies, protocols, procedures or other requirements that AYS, or any related party involved in the program, implements to protect the health and wellbeing of those who participate in or otherwise attend AYS events, including, without limitation, temperature checking and physical distancing in accordance with the guidelines recommended by the CDC or other public health agencies. I fully understand and appreciate both the known and potential dangers of participating in and attending AYS events and acknowledge that participating in or attending such events may, despite AYS’ efforts to mitigate such dangers, result in exposure to COVID-19, which could result in quarantine requirements, serious illness, hospitalization, disability and/or death. On behalf of myself and the player, I voluntarily assume all such dangers and risks and accept sole responsibility for any illness, loss or Liability that may result from participating in or attending any and all AYS events.I understand and acknowledge that changes to the program may be required based on a pandemic event, other force majeure event, or other event outside of AYS's control, including but not limited to, state orders and changes of policies associated with entities AYS relies upon to offer it's programs (tournament directors, facility/court operators, etc.), and that potential changes include, but are not limited to, delays in the schedule, the change of format or location of program events, and suspension or cancellation or the program. I acknowledge the resources and upfront and ongoing material fixed expenses that AYS incurs in the preparation and execution of this program, and that if the program must be canceled that I will not receive a refund but rather an account credit (for use in future programs) that is reflective of the planned program costs that AYS no longer incurred after the cancellation of the program, irrespective of the number of sessions canceled. I further acknowledge that if my child stops participating in this program and the program has not been canceled, that I will not receive any refund or account credit. I acknowledge and agree that the waiver in the General Terms and Conditions above extends to any Liabilities arising due to any person contracting or transmitting COVID-19 or other virus as a result of participating in or attending any and all AYS events.Do you acknowledge your understanding and acceptance of these Supplemental Terms and Conditions? Yes Done