Athletes Name *

Athletes Date of Birth *

Athletes Phone Number *

Name of High School *

High School Graduation Year *

Athletes Current Address

Athletes Email

AAU Team

AAU Coach

Position *

Why do you want to join the BYB Academy? *

Do you have any offers to play college basketball? *

If yes, Which colleges/universities?

Have you played basketball in college ? *

T-shirt Size *

Parent / Guardian Name *

Parent/Guardian Phone Number *

Parent/Guardian Email Address *

How did you hear about BYB Academy

Medical Release: It is expected that your family health insurance will serve as primary coverage in case of injury. If your child becomes ill during the training and is unable to participate in activities, the parent/guardian will be notified immediately. If your child is hurt, a member of the staff or an authorized person will administer immediate first aid. If the situation should require immediate medical attention, Bria Young will attempt to contact and inform the parent/guardian as soon as possible. In the event that the parent/guardian cannot be reached, the emergency contact person will be called. Bria Young will call the designated physician and/or local emergency unit for treatment and/or transportation to a hospital if no contact person is available. A staff member will accompany the athlete to the hospital and stay until the parent/guardian arrives.I HEREBY GIVE PERMISSION TO BRIA YOUNG’ BASKETBALL, INC.ITS OFFICERS, EMPLOYEES, AGENTS, ATHLETIC TRAINERS, OR STAFF MEMBERS TO TAKE WHATEVER ACTION IS NECESSARY FOR THE HEALTH AND WELFARE OF MY CHILD INCLUDING CONSENTING ON MY BEHALF TO ANY AND ALL MEDICAL TREATMENT, PROCEDURES, OPERATIONS AND OR HOSPITALIZATION AND I FURTHER AGREE TO HOLD THEM HARMLESS AND INDEMNIFY THEM FOR ALL MEDICAL BILLS INCURRED FOR THE TREATMENT OF MY CHILD. I UNDERSTAND THAT BASKETBALL IS A PHYSICAL SPORT, WHICH CAN RESULT IN SERIOUS INJURY. I HOLD BRIA YOUNG BASKETBALL INC, ITS OFFICERS, EMPLOYEES, AGENTS, TRAINERS OR STAFF MEMBERS HARMLESS AND HEREBY RELEASE THEM FROM LIABILITY FOR ANY INJURY TO MY CHILD WHILE ATTENDING BASKETBALL TRAINING.I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND BRIA YOUNG BASKETBALL INC AND SIGN IT ON MY OWN FREE WILL. *

Emergency Contact Name *

Emergency Contact Phone *

Athlete Electronic Signature *

Parent/Guardian Electronic Signature *