GBA - Free Clinic - Waitlist
We have a waitlist for our upcoming free clinic at Brambleton Middle School on Saturday, 3/14 from 10am to noon. Please fill out this form and we will notify you if space opens up.

By registering you agree to the following:
I wish to register for the GBA clinic. By agreeing, I am stating that I give permission for my child(ren) to participate in all activities and that I understand the possible risks involved with this type of activity. I absolve the County of Loudoun, organizations jointly sponsoring the clinic, and owners of the clinic site location of any responsibility for any accident or injury to my children(s) or caused by my children(s) to others where neglect is not involved. Also, by signing below, I give permission to Loudoun County Parks and Recreation (PRCS) and Giant Basketball Academy to use photographs and videos of my child for publicity in order to increase community awareness and in any and all publications and other media without limitation.
Your Name (Parent or Guardian) *
Email *
Participant First Name *
Participant Last Name *
Participant Date of Birth *
Participant Gender *
How did you hear about this free clinic?
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