Girls Basketball Clinic Registration 2022
Led by experienced basketball and sports performance coach Juan Perez, this clinic is designed to help players develop their leadership ability, shooting, passing, ball handling, and finishing moves. In addition, it will incorporate exercises designed to improve speed, agility, and quickness with and without the ball. Coach Perez has trained hundreds of athletes, most notably current Philadelphia 76'ers starter and NBA star Matisse Thybulle, Markelle Fultz of the Orlando Magic and WNBA star Kelsey Plum of the Las Vegas Aces. Juan has also trained many overseas professionals and Division I standouts along the way. This clinic is exactly what you need to level up your game this off-season, don't miss it! Limited to 15 participants.
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Participant's Name *
Date of Birth *
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Does your child have any health concerns or take any medications? *
Age Group *
How much basketball experience does the participant have?
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Is the participant a Boys & Girls club member or has been a member in the past year?
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Participant's Shirt Size *
Parent/Guardian Name(s) *
Parent/Guardian Email *
Address *
Cell Phone Number *
Alternate Phone Number
Parent/Guardian Pledge and Release of Liability *
Parent Pledge ▪ I will remember that children participate to have fun and that the game is for youth, not adults. ▪ I will inform the coach of any physical disability or ailment that may affect the safety of my child or the safety of others. ▪ I will learn the rules of the game and the N.Y.S.A. policies. ▪ I (and my guests) will be a positive role model for my child and encourage sportsmanship by showing respect and courtesy, and by demonstrating positive support for all players, coaches, officials and spectators at every game, practice or other sporting event. ▪ I (and my guests) will not engage in any kind of unsportsmanlike conduct with any official, coach, player, or parent such as booing and taunting; refusing to shake hands; or using profane language or gestures. ▪ I will teach my child to play by the rules and to resolve conflicts without resorting to hostility or violence.▪ I will demand that my child treat other players, coaches, officials and spectators with respect regardless of race, creed, color, gender identity, sex or ability. ▪I will teach my child that doing one's best is more important than winning in an attempt to ensure that my child will never feel defeated by the outcome of a game or his/her performance. ▪ I will praise my child for competing fairly and trying hard, and make my child feel like a winner every time. ▪ I will emphasize skill development and practices and how they benefit my child over winning. I will also deemphasize games and competition in the lower age groups. ▪ I will promote the emotional and physical well-being of the athletes ahead of any personal desire I may have for my child to win. ▪ I will respect the officials and their authority during games and will never question, discuss, or confront coaches at the game field, and will take time to speak with coaches at an agreed upon time and place. ▪ I will demand a sports environment for my child that is free from drugs, tobacco, and alcohol and I will refrain from their use at all sports events. ▪ I will refrain from coaching my child or other players during games and practices, unless I am one of the official coaches of the team.  ▪I also agree that if I fail to abide by the aforementioned rules and guidelines, I will be subject to disciplinary action that could include, but is not limited to the following: ◦Verbal warning by official, head coach, and/or head of league organization  ◦ Written warning  ◦ Parental game suspension with written documentation of incident kept on file by organizations involved  ◦ Game forfeit through the official or coach  ◦ Parental season suspension  ◦ Removal of my child from the program.  Release of liability: I waive all rights and release all claims that might be had against Juca Elite Performance and BGCSPS, its hired or contracted instructors, and their employees and agents, for any and all injuries or losses which may be suffered because of my participation or my child’s or children’s participation in the above activity offered by the BGCSPS, in consideration of permission of the BGCSPS to participate in the activity. I consent to my child’s participation in the activity/program of BGCSPS and authorize them and their employees or agents to provide emergency medical treatment for my child on my behalf.  To the best of my knowledge, my child has no physical or other conditions that would interfere with his/her participation.
Informed Consent: We accept and understand that the sport of basketball involves certain inherent risks, dangers and hazards that may cause serious personal injury, including death, sever paralysis or brain injury necessitating long term care and significantly impairing enjoyment of life or life activities. We accept and understand that the above-described injuries and other injuries, including, but not limited to: concussions; serious neck and spinal injuries potentially resulting in complete or partial paralysis; brain damage; blindness; serious injury to all internal organs; serious injury to all bones, joints, ligaments, muscles and tendons; contusions; dislocations; sprains; strains; and fractures, may occur as a result of participating in this sport. We accept and understand that certain activities such as batting, fielding and sliding carry with them a greater risk of injury. We understand that the inherent risks of this sport cannot be eliminated without jeopardizing the essential qualities of the sport. We have reviewed all of these risks and we understand and appreciate them and still desire to participate in the activity. We certify that the participant has no medical or physical conditions which could interfere with or compromise their safety in participating in this activity. I authorize qualified emergency medical professionals to examine, and in the event of an injury or serious illness, to administer emergency medical care to the above-named student. In the event it becomes necessary for program staff to obtain emergency medical care for the above-named student, we understand that neither the staff member nor the agency assumes financial liability for the expenses incurred because of the accident, injury, illness and/or unforeseen circumstances. I certify that my household has sufficient medical insurance to facilitate any necessary medical care or resultant care or any injury that may be sustained by the above-name participant. HAVING READ AND INITIALED THE STATEMENTS ABOVE, I ACKNOWLEDGE THAT I HAVE READ THIS DOCUMENT AND FULLY UNDERSTAND THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS VOLUNTARY SPORTS PROGRAM. BY SIGNING BELOW, I CERTIFY THAT I HAVE READ THE ABOVE, UNDERSTAND ITS CONTENT AND WISH TO PARTICIPATE. *
Student/Parent Concussion and Sudden Cardiac Death Awareness: Boys & Girls Clubs of America believe participation in athletics improves physical fitness, coordination, self-discipline, and gives students valuable opportunities to learn important social and life skills. With this in mind, it is important that we do as much as possible to create and maintain an  enjoyable and safe environment. As a parent/guardian or student you play a vital role in protecting participants and helping them get the best from the sport. Player and parental education in this area is crucial which is the reason for the Concussion Management and Sudden Cardiac Arrest Awareness pamphlet you have been directed to read. Refer to it regularly. This form must be signed annually by the parent/guardian and student prior to participation in any specialty clinics. If you have any questions regarding any of the information provided in the pamphlet, please contact the program administrator at your specific Boys & Girls Club location. I UNDERSTAND THE INFORMATION PRESENTED IN THE CONCUSSION RECOGNITION AND SUDDEN CARDIAC ARREST AWARENESS PAMPHLETS. *
Code of Conduct for Spectators: Coaches/Volunteers are responsible for the conduct of their spectators and are expected o make them aware of the Codes applicable to them. Spectators: 1. I will not engage in unsportsmanlike conduct with any coach, parent/guardian, participant, official or any other attendee. 2. I will not encourage my child, or any other person, to engage in unsportsmanlike conduct with any coach, parent/guardian, player, participant, official or any their attendee. 3. I will not engage in any behavior which would endanger the health, safety or well-being of any coach, parent/guardian, player, participant, official or any other attendee. 4. I will not encourage my child, or any other person, to engage in any behavior which would endanger the health, safety or well-being of any coach, parent/guardian, player, participant, official or any other attendee. 5. I will not engage in the use of profanity. 6. I will not encourage my child, or any other person to engage in use of profanity. 7. I will treat any coach, parent/guardian, player, participant, official or any attendee with respect at all times regardless of gender identity, creed, color, national origin, sex or ability. 8. I will not engage in verbal or physical threats or abuse aimed at any coach, parent/guardian,  player, participant, official or any other attendee. 9. I will not initiate nor encourage my child to initiate a fight or scuffle with any coach, parent/guardian, player, participant, official or any other attendee. 10. I will be responsible for the behavior of all those attending the program or sports event on my child’s behalf. 11. I will not shout instructions, coach or direct players on the field from the stands nor the sidelines. 12. I will not address the officials from the sidelines in any manner. Parents/Guardians or anyone attending a program may be asked to exit the facility and not return if and above conducts are violated. This is at the discretion of the building supervisor or officials onsite. *
Photo Consent *
I give my permission to have my photo or the photo of my child or children, taken during the activity used for publicity purposes by BGCSPS and Juca Elite Performance. I consent to the use of my name, likeness and voice of those or those of my children, without monetary compensation, in connections with BGCSPS, Juca Elite Performance, or other video presentations, and with the program publicity, and expressly release BGCSPS, Juca Elite Performance, and its agents from any and all claims for damages for libel, slander, invasion of privacy or any other claim arising out of broadcast, exhibition, promotion, or presentation of this program.
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