Chris Ford Basketball Skills Academy 2021
Location: Crayons 2 Pencils Recreation Center - 515 Sunset Drive Norwalk, IA 50211
Child's First Name *
Finn *
Child's Last Name *
Goche *
What grade is your child currently in *
Required
What school district does your child go to school in? *
Norwalk *
Parents First Name *
Parents Last Name *
Melissa Goche *
Phone number a parent can be reached at while your child is at practice. *
515 250 0908 *
Parents Email Address *
MDoes your child play basketball for a team? If so, what team? *
Norwalk Naturals *
Column 1
Row 1
How many years has your child played basketball for? *
How many years has your child played basketball for? *
Does your child have any allergies? *
Does your child have any allergies? *
No *
I agree to pay the fees at the drop off on the first day of camp. Fees are $100 for the session. I understand that if my child misses a camp, we will not be refunded. Please sign parent/guardians name below. *
Yes *
Release of Liability and Assumption of Risk Agreement
In consideration of my minor child/ward (“my child”) being allowed to participate in this sport camp program, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that:

1. The risk of serious injury from the sports activities involved in this program is always present due to the nature of the sport(s);

2. FOR MYSELF, SPOUSE, AND MY CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation;

3. I willingly agree to comply with the program’s stated and customary terms and conditions for my child’s participation;

4. If, however, I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from participation and bring such to the attention of the nearest official immediately; and

5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the Camp, Chris Ford, Crayons 2 Pencils Preschool, LLC, a limited liability company formed under the laws of the State of Iowa, other participants WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, regarding my child and/or arising from his/her activities or ARISING FROM NEGLIGENCE OF THE RELEASEES TO THE FULLEST EXTENT OF THE LAW.

6. By signing below, I agree to hold harmless and indemnify the Camp, Chris Ford, Crayons 2 Pencils Preschool, LLC, Crayons 2 Pencils Recreation Center a limited liability company formed under the laws of the State of Iowa, other participants from any and all liability, loss, damages, costs, refunds or expenses which are sustained, incurred or required out of the actions of my dependent in the course of the camp. I RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND THEIR TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
I agree to the Release of Liability and Assumption of Risk Agreement. By typing your name it states you agree to the above. *
I agree to the Release of Liability and Assumption of Risk Agreement. By typing your name it states you agree to the above. *
Yes *
What to bring
28.5 Basketball
Water bottle - NO SPORTS DRINKS ALLOWED IN GYM
Please enter through the back door located across from the playground. The front door of the facility will be used by Crayons 2 Pencils Recreation Center for their after school program.
Coach Chris Fords Contact information should you have any questions: 1-347-200-4390 Email: cford3073@gmail.com
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