St. Vincent's Basketball Academy
Summer 2019
Player's First Name *
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Player's Last Name *
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Which Session? *
Current School *
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Parent's Name *
Your answer
Parent's Cell Phone *
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Parent's Email Address *
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T-Shirt Size *
Waiver of Liability: By placing a check in the box on this form, your daughter has permission to participate in the basketball clinics held by St. Vincent’s Academy. I understand participation in the basketball clinic involve a certain degree of risk and can be physically, mentally, and emotionally demanding. I have carefully considered the risk involved and have given consent for my child to participate in the activities at the clinics. I also understand that participation in these activities are entirely voluntary and require participants to abide by applicable rules and standards of conduct. I release St. Vincent’s Academy School, Saint Vincent’s Academy Athletic Department, and all employees, volunteers and related parties or other organizations associated with the activity from any and all claims or liability arising out of this participation.In case of emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give my permission to the medical provider selected by the adult in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant’s parents or guardians and/or determination of the participant’s ability to continue in the program activities. *
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Cost is $50.00 per student, make checks payable to St. Vincent's Academy and is due on June 11! *
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