Columbus Day Shooting Clinic Registration

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Please complete one form per FAMILY

Email *

Player Name(s) *

Current Grade(s)

Clinic Fee *

$60 per player

$50 for Fall AAU Players

Apply credit from Spring programs

Required

Payment Method

Venmo: @Rick-Kilpatrick

Mail a check to: Elevation Basketball Academy, 5 B Street, Maynard, MA 01754

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Name of parent / guardian *

Street Address *

Town and Zip Code *

Home Phone *

Parent Cell Phone *

Please explain if your child has any allergies or medical conditions (including inhalers). Food will not be served but players may bring snacks from home.

COVID-19/ WARNING & DISCLAIMER: Covid-19 is a contagious virus that spreads through person-to-person contact. Federal and state authorities recommend social distancing. Covid-19 can lead to illness, personal injury, disability and possibly death. Participation in this program could increase the possibility of contracting Covid-19. Elevation Basketball Academy in no way warrants that Covid-19 infection will not occur through participation in this program. (BY TYPING YOUR NAME IN THE SPACE BELOW YOU ARE AGREEING TO THE ABOVE WAIVER) * *

I authorize the Director of Elevation Basketball to act according to his best judgment in any emergency medical situation. Please include note explaining any medical conditions.The participant attending the Clinics, and in using the facility, does so at his/her own risk. The Elevation Basketball Academy and its staff shall not be liable for damage arising from personal injury sustained by the participant during the clinics. The participant and his/her parents assume full responsibility for any damages or injuries which may occur and so hereby exonerate the Elevation Basketball Academy, The Millworks in Westford, its staff, and its employees from any and all claims. Also I/We hereby consent to the participation of our son/daughter in the Elevation Basketball Academy. I understand that the Elevation Basketball Academy does not carry insurance for the participants. (BY TYPING YOUR NAME IN THE SPACE BELOW YOU ARE AGREEING TO THE ABOVE WAIVER) *

Please read the Elevation Basketball Academy Cancellation policy below carefully. (BY TYPING YOUR NAME IN THE SPACE BELOW YOU ARE AGREEING TO THIS POLICY) REFUND POLICY: For withdrawal within one week of the start of any program and beyond, there will be no refunds, but credits will be issued in some circumstances. Withdrawals can include injuries and other extenuating circumstances. Cancellation outside of one week, will be refunded minus a $25 administrative fee. *

Photos & Videos: During the course of an event Elevation Basketball Academy may take photos or videos for use on their website. Is this ok?

YES

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