Pickup Walk-Ins/Same Day Registration
Note: Please complete a form for EACH player/sibling participating 

WHAT: Wednesday night pickup games consisting of ~20 minutes of skill-building and ~60 minutes of player-led scrimmaging (light coaching)

WHEN:  10 sessions on April 8, 15, 22, 29, May 6, 13, 20, 27, June 3, 10  

WHAT TIME: 6:00 to 7:30pm

WHO: Girls and Non-Binary Players Ages 9 to 14 

WHERE: Old Pine Community Center (OPCC), 401 Lombard Street, Philadelphia PA, 19147  

COSTS: $100 for all 10 sessions; $15 to drop in; Send payment via Venmo to @Michael-Casey-1 (associated with phone number ending in #7202)
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Email *
Player LAST Name:  *
Player FIRST Name: *
Player Gender: *
Player Date of Birth (MM/DD/YYYY): *
Parent/Guardian 1 Name: *
Parent/Guardian 1 Cell: *
Parent/Guardian 1 Email: *
Parent/Guardian 2 Name:
Parent/Guardian 2 Cell:
Parent/Guardian 2 Email: *
Child Health Concerns: *
Emergency Contact Name: *
Emergency Contact Phone #: *
My child will attend the following:  *
WINTER 2026 SKILLADELPIA PARTICIPATION WAIVER OF LIABILITY AND ASSUMPTION OF RISK
In consideration of my child being allowed to participate in Skilladelphia Basketball Academy (SBA) related events and activities, the checkbox below acknowledges, appreciates, and agrees that:                  
1. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS on behalf of my child, both known and unknown, and assume full responsibility for my child’s participation.

 2. I hereby release, waive, discharge, and hold harmless the SBA, its directors, officers, employees, agents, volunteers, sponsors, and successors from any and all claims, demands, liabilities, losses, costs, or expenses (including attorneys' fees) arising out of or in connection with my child's participation in SBA activities.

3. I agree to provide my child with adequate medical insurance coverage for their participation in SBA activities.

4. I agree to notify SBA immediately of any known or suspected injuries to my child.

5. I agree to comply with all COVID-19 protocols set forth by OPCC.

6. I hereby grant permission to SBA and its authorized representatives to take photographs and/or video recordings of my player(s) (if applicable) during participation in SBA activities. Content will be used for the sole purpose of promoting SBA activities and/or for learning purposes (i.e., shot analysis videos). If I do not grant permission for this, I will notify SBA by sending a written request to mac@skilladelphiabasketballacademy.org in advance of participation.

This waiver and release shall be binding upon my child and their heirs, personal representatives, and assigns.

In witness whereof, I have executed this waiver and release by checking the box below.

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