KLDragons Basketball Academy
Registration form Jan-Apr 2019
Email address *
Participant's name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Address *
Your answer
City
Your answer
Zip Code
Your answer
State *
Phone number (01x-xxx xxxx) *
Your answer
Email *
Your answer
Current School
Your answer
List of any Medical Problems:
Your answer
Parent/Guardian’s Name: *
Your answer
Parent/Guardian's Phone Number (01x-xxx xxxx) *
Your answer
Parent/Guardian's Email
Your answer
Training dates, please select either one *
Term Fee
Venue 1: Garden International School (Undercover Basketball Court beside the canteen or the tennis court) @ 16 Jalan Kiara 3, Mont Kiara, 50480 Kuala Lumpur.
WAIVER AND RELEASE AS REQUIRED BY KL DRAGONS BASKETBALL ACADEMY FOR ALL PARTICIPANTS:
I hereby authorize any medical evaluation or treatment which may be advised or recommended by the attending physician of the participant name above while at the KL Dragons Basketball Academy. In consideration of my application being accepted, intending to be legally bound, do hereby, for myself, my heirs, executors and administrators, waive, release and forever discharge any and all claims for damages, which may or may not hereafter occur to me, against KL Dragons Basketball Academy or their respective officers, agents, representatives, successors and/or assigns, for any or all damages which may be sustained or suffered by me or participation at the training venue. I, the parent or guardian, do hereby agree to the above waiver and release. I also grant the KL Dragons Basketball Academy right to use any photographs of activities in future promotional materials. I pledge his/her compliance to any and all academy rules and understand that he/she could be dismissed from the academy for any conduct not in the best interests of the academy or its participants and that no part of participant’s tuition fee will be refunded.
A copy of your responses will be emailed to the address you provided.
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