Event registration
Event Timing: October 9th, 16, 23rd. November 6th, 13th, 23rd 2021
Event Address: Dzantiki Heeni Middle School
Contact us at (907-723-4525) or Lori Seymour Seymour907@outlook.com
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Email *
Name of youth (last, first) *
Parent or Guardian Name and Contact Number *
What grade is the youth currently in? *
Select the session(s) you would like to sign up for. *
HoopTime COVID 19 Waiver and Release
HoopTime is working with Community Schools to provide basketball activity to the extent possible during the current COVID-19 pandemic. Providing activities during this time cannot be done without inherent risk to all participants. HoopTime and Community Schools are planning and may plan to allow activities to take place. This effort to provide activities come with inherent risks.

In consideration of being permitted to practice, compete, officiate, observe, work or participate in an ACTIVITY, I for myself and my children agree to the following:
1. I affirm that neither I nor my children, nor anyone in my immediate household (including the actual participant(s) in the Activity are currently diagnosed with, demonstrate any symptoms of, or have in any way been exposed to any communicable diseases, including the novel corona virus known as COVD-19.
2. I agree that I will immediately notify a HoopTime administrator if, I my children, or anyone in my immediate household is diagnosed with the corona virus known as COVID-19. I understand that this notification requirement is critical to limit the spread of the virus.
3. I acknowledge that I am aware that by entering any HoopTime “event” premises and participating in the “event” that there are inherent risk to me and my children of being exposed to COVID-19, and/or any mutation or variation thereof. I am also aware that such an exposure can occur directly or indirectly.
4. I understand that certain individuals may be more susceptible to becoming seriously ill if they contract COVID-19, including people over the age of 65, people with serious underlying health conditions, including high blood pressure, chronic lung disease, diabetes, obesity, asthma, and those whose immune systems are compromised. I understand that if I or my children, including that actual participant(s) in the “event”, or a household member fall within one or more of these categories, there could be greater risk that I should discuss with my health care provider.
5. I understand that while HoopTime strives to provide safe “events’ by following recommendations and protocols intended to reduce the risk of COVID-19, HoopTime and Juneau Community Schools cannot eliminate all risks. HoopTme and Juneau Community Schools may make unintentional mistakes when trying to eliminate or mitigate the risks of contraction COVID-19. By signing this Waiver, I ASSUME ALL RISKS on behalf of myself and my child/children regarding the possibility of contracting the novel corona virus know as COVID-19 or any mutation or variation thereof.
6. I herby voluntarily agree to RELEASE, WAIVE, DISCHARGE, and COVENANTT NOT TO SUE HOOPTIME and /or its officers, directors, and coaches and any individuals, companies, or associations having anything to do with an ”event”, including but not limited to promoters, participants, officials and owners of the premises where the “event” takes place (collectively referred to as “RELEASES”). By signing this document, RELEASES WILL BE RELEASED FROM ANY AND ALL LIABILITY for any and all loss or damage whether caused by the negligence of the Releases or otherwise related to possible exposure or contracting of the novel corona virus known as COVID-19 or any mutation or variation thereof; and
7. I hereby agree to INDEMNIFY AND HOLD HARMLESS the Releases form any loss, liability, damage or cost (including reasonable attorney’s fees) they may incur arising out of or related to my illness or death of my children, including the actual participant(s) in the “event” whether caused by negligence of the Releases or otherwise.
After reading the HoopTime Covid-19 Waiver and Release above check the box below to grant permission for your youth to participate. *
Screening Questions (The youth participant must be able to answer "NO" to all of the following questions before being permitted to enter the gym.
Have you had a fever in the last 72 hours?
Do you have a persistent cough?
Do you have a sore throat?
Are you experiencing any unusual shortness of breath?
Have you had close contact with anyone who has a confirmed case of COVID-19 in the past 10 days or is there someone in your household who has COVID-19 symptoms and is awaiting test results OR has symptoms and has elected not to be tested?
Have you, or anyone in your family, traveled outside of Alaska in the last 5 days?

→ Temperature will be taken (Sent home if over 100*F).
I have read and understand the screening questions. *
A copy of your responses will be emailed to the address you provided.
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