NewFlex Youth Programs SUMMER SPORTS PROGRAMS (hoops and more)("Book In hand")

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Executive Director: Coach Felix Phone: 718-954-0932 Other: 716-393-5399
Drop Off & Pick Up: Cecil H Parker Elementary 461 S 6th Ave, Mt Vernon, NY, 10550
SEE CALENDAR FOR MORE EVENT DETAILS: www.newflexhoops.com
PAYMENT: Paypal/Zelle-newflexhoops@2gmail.com Cashapp-$NewFlex Venmo @Nesta-Felix

PAY jjjjj $$$$$$$$

Email *

DATE

YYYY

CHILDS DATE OF BIRTH

YYYY

I Give Permission for My Child To attend: CHILD NAME

School Affiliation

PARENT/GUARDIAN NAME

PARENT PHONE:

PARENT EMAIL:

ADDRESS

IS PARENT AVAILABLE TO CHAPERONE SOME DAY OR TRIP

YES

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NAME OF PARENT CHAPERONE ATTENDING if different from above:

AUTHORIZED ADULT WILL BE PICKING UP MY CHILD/OR CHILD WALKS HOME

HEALTH INFORMATION

My child has allergies

My child can not participate in certain activities

My child has specific needs that require special attention

Will your child be taking medicine

I authorize NewFlex Summer Program personnel to seek emergency treatment as required and to transport my child to the appropriate medical facility in the event that urgent/emergency care is necessary

I authorize

Physicians Name

Insurance Carrier (IF NONE PLEASE INDICATE)

Policy Holder Name

LIABILITY WAIVER - PHOTO WAIVERS & Indemnity Clause: I hereby authorize use of my pictures /my child's pictures or videos, taken during involvement in NewFlex Hoops Inc, to be used for promotional purposes (website, brochures, etc.) _______________________________________________ I hereby release and discharge NewFlex Hoops, the hosting school and affiliated entities, and their respective officers, servants, agents or employees from any and all liability whatsoever arising out of or in connection with my participation, or my child’s participation in the NewFlex Hoops/Youth Programs Hair Show Pageant. (Minors must have this permission slip completed by parents or legal guardians)

I AGREE

EMERGENCY CONTACT INFORMATION:

EVENT-TRIP-OR PROGRAM FEE PAY HERE $$$$$

PLEASE SUBMIT PAY AFTER SELECTION

$100/Week Summer Program Sports (Member)

$400/ FULL SUMMER (Member)

$300/Week Summer Program Sports (Non Member)

$1000/ FULL SUMMER (Nonmember)(Includes Camping Retreats & Brant Lake)

$40 Jersey (Mandatory) (youth can use jerseys from previous NewFlex programs)

$100 Ladies Weekend Camping Leadership Retreat (July 7-9)

$100 Guys Weekend Camping Leadership Retreat (July 14-15)

$80 BRANT LAKE-CAMPING WEEKEND (Aug22-24)

$300 2nd Child & Referral Scholarship

$250 Counselor In Training (CIT) (upon approval and interview-15yr plus)

SUMMER HOOPS (select for concentrated summer experience)

SUMMER VOLLEYBALL (select for concentrated summer experience-select days)

SUMMER DANCE (select for concentrated summer experience-select days)

COLUMBUS NR Scholarship (By Reg Only)

SUMMER TENNIS (beginners concentrated summer experience)

CECIL PARKER SCHOLARSHIP

EDWARD WILLIAMS SCHOLARSHIP

Other:

PAYMENT TYPE PAY HERE $$$$$$

Zelle newflexhoops@gmail.com (preferred)

Cash APP $NewFlex

Venmo @NewFlex

Cash or Check to NewFlex Youth

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