VERSATILE BASKETBALL WINTER JUNIOR PROGRAM REGISTRATION FORM ( 9yrs -12yrs )
Location: Lower Canada College 4090 Royal N.D.G.
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Email *
THE PROGRAM

- 10 weeks from Sunday January 22nd - April 2nd 

- Each session is 90 minutes and will be divided as 45 minutes practice and 45 minute games.

- Session is from 9:00-10:30 AM

- Includes jersey

- Teams will be coached by real trainers, not parents.

Price: $225 tax included


Player's Name *
Address *
City/Borough *
Postal Code *
Age at the time of camp *
Date of Birth *
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Name of Child's school *
Is this your child's first time playing basketball? *
Which team does your child play for?
What is your child's level of basketball? *
Medicare Card Number *
Does your child have any allergies? *
Please list any allergies and/or Dietary Restrictions
Does your child carry an Epi-pen? *
Please list any medications being taken. Indicate dosage and frequency
Please list any Medical / Behavioural conditions
Parent/Guardian 1 Name
 *
Parent/Guardian 1 Cell Number
 *
Parent/Guardian 1 Phone Number
Parent/Guardian 2 Name

 *
Parent/Guardian 2 Cell Number

 *
Parent/Guardian 2 Phone Number
Where did you hear about this program? *
If you answered other, please specify
Child's T-Shirt size *
Height *
Weight *
Pricing for the session is $225 tax included 
Medical Emergencies.

In the event of an accident, injury or illness involving the registrant, and the immediate parent or guardian cannot be reached, I hereby authorize and grant permission to The Versatile Basketball Program staff to secure proper medical treatment and authorize on the registrants behalf all procedures, including, without limitation, admission to an emergency unit, hospital and treatment therein, ordering of x-rays, tests or treatment, injections, anesthesia and/or surgery, as deemed necessary by the attending medical professional(s). I agree not to hold The Versatile Basketball Program responsible for any costs or injury arising out of an emergency situation.
 *
Required
Name of Emergency Contact (emergency contact is authorized to pick up your child(ren)
 *
Phone Number of Emergency Contact *
COVID-19
The Versatile Basketball Program will follow all health guidelines recommended by Public Health to the best of their ability. By registering their child, Parent(s)/Guardians understand that The Versatile Basketball Program, following all safety protocols, cannot 100% guarantee non-exposure to COVID-19, and will not hold The Versatile Basketball Program accountable should their child(ren) be exposed or contract the virus. Parent(s)/Guardian will assume responsibility in ensuring they do not send their child to the basketball program, should they show any symptoms of Covid-19 as outlined by Santé Quebec. Upon registering and signing this form, parent(s) guardians accept any potential risk of their child contracting Covid-19, and understands that should an outbreak occur, The Versatile Basketball Program may not be held responsible.
ASSUMPTION OF RISK AND INDEMNIFYING RELEASE
The parent/Guardian of the above named child hereby consent that he/she may participate in any and all of the Versatile Basketball Program activities. I hereby release and discharge the Versatile Basketball Program, its organizers and its directors and any and all volunteers from any and all future claims or demands for loss, damage or bodily injuries which may result directly or indirectly from participation in the said activity.
PHOTO AND VIDEO CONSENT
The Versatile Basketball Program reserves the right to photograph and videotape my child’s classes and/or activities, and use them for future publicity for our camps and programs.
Cancellation Fees
The Versatile Basketball Program reserves the right to cancel the program for which there is insufficient registration or due to unforeseen circumstances; in such a case, a full refund will be given. There will be a 50% cancellation fee per child, for any emergency cancellation. No refund will be given after the first day of the program.

By Initialling this document electronically, I have fully read and agreed to all the terms in this document
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Please enter your initials  *
Please add the date on which you have filled out and initialled this form
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PAYMENT
Once your registration form is complete, please send us an E-Transfer of $225 to: versatilebasketball@gmail.com. In the E-Transfer message add your full name and your child's full name. Thank you.
A copy of your responses will be emailed to the address you provided.
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