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First Name

Last Name

Phone

Birthday

High School You Attend

Shirt Size

Parent/Guardian Name (First & Last) - if player is under 18.

Email (Parent email if player is under 18)

Does the player have any allergies, illness, or medical conditions? If yes, please describe:

Informed Consent and Acknowledgement I hereby give my approval of participation in any and all activities prepared by Trusted Legacy during the selected clinic. In exchange for the acceptance of named athlete by Trusted Legacy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Trusted Legacy and all its respective officers, agents, and representatives from any and all liability for injuries to named athlete arising out of traveling to, participating in, or returning from selected clinic sessions. In case of injury to named athlete, I hereby waive all claims against Trusted Legacy, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the named athlete, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the named athlete’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible (parents with registered minor participants). This authorization is granted only after a reasonable effort has been made to reach me (parents with registered minor participants). Permission is also granted to Trusted Legacy and its affiliates including Directors, Coaches, and Facility personnel to provide the needed emergency treatment prior to the named athlete’s admission to the medical facility. Release authorized on the dates and/or duration of the registered clinic. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named athlete, in my absence (parents with registered minor participants). I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Trusted Legacy and all its respective officers, agents, and representatives from any and all liability for injuries to named athlete arising out of traveling to, participating in, or returning from selected clinic sessions. In case of injury to named athlete, I hereby waive all claims against Trusted Legacy, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the named athlete, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the named athlete’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible (parents with registered minor participants). This authorization is granted only after a reasonable effort has been made to reach me (parents with registered minor participants). Permission is also granted to Trusted Legacy and its affiliates including Directors, Coaches, and Facility personnel to provide the needed emergency treatment prior to the named athlete’s admission to the medical facility. Release authorized on the dates and/or duration of the registered clinic. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named athlete, in my absence (parents with registered minor participants).

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Your Signature

Select an item ($)

Single Player - $100

Player with Team - $80

Thanks for registering to our event. See you there!