Registration Form - 2018 Blazers April Vacation Basketball Camp

2018 Blazers April Vacation Basketball Camp
(for children in 3rd-9th Grade)

April 17-20 at St. Mark's, Southborough (Tuesday - Friday 9:15am-3pm)

Hi Parents - Our camps are designed to help players develop sound fundamentals, in an uptempo and competitive setting that they enjoy. Each program is designed to support the specific needs of the targeted age group, and leverages the skill development model we've developed for youth leagues in more than 30 states. We ensure players understand the proper mechanics for all of the core skills, and then work with them to incrementally develop the ability to execute these skills in game-like competitive situations. We often incorporate a strength and conditioning component to our programs, helping players understand the importance of fitness in all the sports they play...as well as to a healthy lifestyle. We will also have skills challenges and the players will have plenty of opportunity to scrimmage.

PRICING: 9:15am-3pm: $275

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* 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 WILL BE in September?

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* 3. Gender of Player:

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* 4. What Town is the player from?

Ashland

Bellingham

Dover

Framingham

Holliston

Hopkinton

Hudson

Marlborough

Medway

Milford

Natick

Northborough

Sherborn

Shrewsbury

Southborough

Sudbury

Wellesley

Westborough

Other (please specify)

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* 5. Will you need to drop off your child early or pick them up late? If so, please specify which days you would like to do this and what the likely times would be. If you aren't sure of the times yet, but believe you will need an early drop off or late pickup, please identify that here.

Yes

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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 the Town of Southborough, St. Mark's, Alpha Youth Sports, or any of the parties 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 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