Registration Form - 2017 Blazers Fall Skill Development Program

*************** PLEASE READ THESE NOTES BEFORE REGISTERING ***************

The "Skills Factory": Program Details:
Program Dates and Times: Players can choose either Monday or Tuesday nights starting the week of September 11th. There will be 8 sessions. We will skip Halloween on Tuesday 10/31, so the Monday sessions will conclude on Monday 10/30 and the Tuesday sessions will conclude on Tuesday 11/7. Last year several players did both nights! See Below for Start Times.

- This will be a VERY uptempo and challenging skills development program. Each 2 hour session will include 80 minutes of basketball skills stations, 20 minutes of Strength & Conditioning work, and then an optional 20 minute full court Scrimmage. No worries if you want/need to pickup your son/daughter early (hence why we've put the S&C work and optional scrimmage at the end).
- The program will be held at The Harlow Gym at The Fay School in Southborough
- The program fee is $150 (Please note that the program fee is NON-REFUNDABLE)

Start Times:
Most players want to be grouped with kids of roughly the same age/grade, so after we have received all registrations, we finalized the player groupings and the associated start times as listed below.

Mondays:
Girls All Grades 6:00
Boys Grade 3 6:00
Boys Grade 4 6:20
Boys Grade 5: Hopkinton, Northborough 7:00
Boys Grade 5: Other 6:40
Boys Grade 6: Westborough, Holliston 7:20
Boys Grade 6: Other 7:00
Boys Grade 7: Framingham, Shrewsbury. Westborough 7:40
Boys Grade 7: Other 7:20
Boys Grade 8-10 7:40

Tuesdays:
Girls Grades 3-6 6:00
Girls Grades 7-10 6:20
Boys Grades 3-4 6:00
Boys Grade 5 6:40
Boys Grade 6 7:00
Boys Grade 7-10 7:20

Registration:
Please fill out all of the information below, using both upper and lower case as appropriate (i.e., please do not leave ALL CAPS on when you fill this out).

Question Title

* 1. Player Information:

First Name: *

Last Name: *

DOB (MM/DD/YYYY): *

Allergies or other Physical/Medical Concerns:

Medical Insurance: *

Policy #: *

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* 2. The Grade the Player IS or WILL BE in September?

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* 3. Gender of Player:

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* 4. The Player is from what town?

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* 5. Session you are registering for:

Boys Program - Monday Nights

Boys Program - Tuesday Nights

Girls Program - Tuesday Nights

Girls Program - Monday Nights

Comments:

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* 6. Parent1 Information

First Name: *

Last Name: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Cell Phone: *

Email Address: *

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* 7. Parent2 or Other Emergency Contact

First Name:

Last Name:

Cell Phone:

Email Address:

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* 8. TERMS AND CONDITIONS:

Waiver: As the parent or legal guardian of the participant 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 mental disabilities or infirmities that would restrict full participation in these activities, except as listed above. 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 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 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 basketball 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.

Program Dismissal: I understand that if my child becomes a discipline problem, he/she will be dismissed from the program, and that no money will be refunded.

Do you acknowledge your understanding and acceptance of these Terms and Conditions?

Yes