Grentz Elite Training Registration Form 2014

Grentz Elite Training 2014
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Parent Emergency Contact Info
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  2. (valid email required)
Insurance Information
  1. (required)
  2. (required)
Insurance Waiver
  1. If player is NOT covered by insurance, a parent or guardian must initial the following agreement:
  2. I will take full responsibility for all uncovered medical expenses incurred by the player during the session.
Informed Consent
  1. In consideration of being permitted to participate in any way in the Theresa Grentz Developmental Basketball Session, the parent(s) and/or legal guardian(s) of the minor participant named above agree: ---That participation is voluntary and at my/minor's own risk; ---That a basketball practice is a physical activity involving heavy exertion. A camp participant must be in good general health, free from cardiovascular and respiratory disease, or other diseases or ailments and have good exercise tolerance; ---That while participating in a basketball practice the human body is subject to a variety of influences that may become potentially hazardous. Some of these hazards include, but are not limited to, severe head injury and a variety of other bodily injuries such as broken bones, including the potential for permanent disability and/or death;
  2. Not withstanding these risks, for and in consideration of the minor's participation, I, for myself, the minor, and the minor's assigns and heirs do waive, release, and discharge Grentz Elite Coaching, Theresa Grentz, practice venues, clients, other participants, and employees from any and all claims, demands, actions, causes of actions, costs and expenses for and by reason of any personal injury, property damage, loss and expense, which heretofore have been or hereafter may be sustained or suffered by the minor in consequence of and as a result of a certain accident, casualty or event or the minor's presence or activities in connection with this developmental basketball session. I also agree to indemnify and hold harmless Grentz Elite Coaching and its employees for injuries sustained either by the minor and/or caused by the minor to others during the basketball session. Furthermore, I acknowledge that the risks outlined above are not intended to be all-inclusive and voluntarily accept all risks known or unknown. With my electronic signature below, I grant Grentz Elite Coaching, LLC to use my minor's image and likeness in promotional materials.
Pick 10 Dates
Payment Method
  1. At this time, we only accept check or cash. Coach Grentz must receive your payment at the start of the first session. Cost: $500.00 for 10 sessions.
  2. Choose Your Payment Method
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  2. After clicking register, you will receive a confirmation email within 48 hours acknowledging that we have processed your registration.
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