Youth Clinic hosted by CCHS Girls Basketball
Saturday, February 10, 2024 Youth Clinic
Please complete the form below. Payment can be made by PayPal at https://www.paypal.com/donate/?hosted_button_id=377G36CFARNAG or by mailing a check to Friends of CCHS Girls Basketball, 833 Old Road to Nine Acre Corner, Concord, MA 01742. If you have any other questions, please email cchsgirlsbasketball100@gmail.com.

Clinic cost is $50 per participant. All proceeds benefit the CCHS Girls Basketball program.

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Test player 1 *
Contact email *
Player Grade *
Parent/guardian name *
Phone Number *
Parent/guardian (2) name
Phone Number (2)
Emergency Contact Name/Number *
Allergies/medical alerts for your player (please write "none" if none) *
I authorize the coaches of the clinic to seek medical treatment for the player listed above in the event of an emergency.   *

Waiver and Release. I understand that participation in this event by the child listed above ("Player") involves a certain degree of risk that could result in injury, death or loss or damage to a person or property. 

On my behalf and on the behalf of the Player, and our heirs, successors and assigns, I release, discharge and covenant not to sue Concord Public Schools, Carlisle Public Schools, Concord-Carlisle Regional School District, CCHS Girls Basketball, Friends of CCHS Girls Basketball, Inc., and their employees, officers, directors, agents, volunteers, students and members, from any and all liability, claims, costs, demands or causes of action, for injuries or damages arising out of Player’s participation in this event. I further agree that if, despite this Waiver and Release, the Player or I, or anyone on our behalf, makes such a claim against any of the Released Parties, I will indemnify, save and hold harmless each of the Released Parties from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred as the result of such claim. 

I consent to the use of photographs/videotape of Player taken during the course of the Activity for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet or other media sources). 

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