REACH BASKETBALL REGISTRATION FORM
Please complete this registration form to participate in the Reach 3-Day Basketball Clinic!
Email address *
Dates: July 18th - July 20th || Time: 10AM - 4PM
Cost: $60 || Open to ages 9 - 18
Participant's Info
Name *
Age *
Address *
City & Zip *
School *
Grade *
Parent/Guardian Name *
Phone Number *
Emergency Contact
Name *
Relationship To The Participant *
Phone Number *
Any allergies or injuries REACH personnel should be aware of:
Please list any medication(s) your child is currently taking or allergic to:
LIABILITY RELEASE AND MEDICAL CONSENT
In consideration of being accepted by Calvary Chapel Okinawa for participation in the REACH 3-Day Basketball Clinic, I do hereby release, forever discharge and agree to hold harmless Calvary Chapel Okinawa, its Pastors,
and agents thereof from any and all liability, claims or demands for personal injury, sickness, death, losses or damages which may be incurred by the undersigned while participating in the REACH 3-Day Basketball Clinic.
I Further hereby agree to hold harmless and indemnify Calvary Chapel Okinawa, its pastors, employees and agents from any and all liability and claims arising from negligent, willful or intentional acts of said participant, including expenses incurred.
I consent to and authorize any medical treatment or care to the above named child in the event of any injury or illness resulting from participation in the REACH 3-Day Basketball Clinic. The undersigned agrees and shall be liable to pay all costs and expenses incurred in connection with such medical services and to discharge and hold harmless Calvary Chapel Okinawa, its pastors, employees and agents against any liability and claims resulting from or connected with such medical treatment or care. I have read and I understand the content of the liability release and medical consent form.
I fully understand and agree to the above LIABILITY RELEASE AND MEDICAL CONSENT terms. *
Date *
MM
/
DD
/
YYYY
PHOTO CONSENT RELEASE
I hereby grant full permission to Calvary Chapel Okinawa and the REACH Basketball Outreach Ministry to use my child’s photograph in any publication or advertising materials (printed or electronic). In giving my consent, I hereby release and hold harmless Calvary Chapel Okinawa, its pastors, agents, employees and volunteers from any and all responsibility and liability. I understand that I will receive no compensation should any photographs of my child be used:
I fully understand and agree to the above PHOTO CONSENT RELEASE terms. *
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy