THE LAB Basketball Registration Form for New Players

Registration Form

Please fill in the form below.
Participant Information
Athlete's Name *

PrefixFirst NameLast Name
Date of Birth*

MonthDayYear
Parent/Guardian Name *

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
E-mail*
Emergency Contact & Information
Emergency Contact Name *

PrefixFirst NameLast Name
Relationship to Participant*
Emergency Contact Number*

Area CodePhone Number
Does your child have any allergies, chronic illness, or medical conditions that would limit high level activity?*
Sessions (multiple sessions can be selected for an additional cost)
SUMMER SESSIONS - 10 weeks (May 22nd - July 28th, 2023)

Ages 12-14 every Monday 6:00pm - 7:00pm (starts May 22nd)Ages 14-15 every Tuesday 6:00pm - 7:00pm (starts May 23rd)Ages 15-16 every Tuesday 7:10pm - 8:10pm (starts May 23rd)Ages 16+ every Tuesday 8:20pm - 9:20pm (starts May 23rd)Ages 12-14 every Wednesday 4:45pm - 5:45pm (starts May 24th)Ages 15-17 every Wednesday 6:00pm - 7:00pm (starts May 24th)Ages 14-15 every Thursday 6:00pm - 7:00pm (starts May 25th)Ages 15-16 every Thursday 7:10pm - 8:10pm (starts May 25th)Ages 16+ every Thursday 8:20pm - 9:20pm (starts May 25th)Ages 16+ every Friday 6:00pm - 7:00pm (starts May 26th)Saturdays - (open schedule) first come first serveSundays - (open schedule) first come first servePrivate sessions and and group sessions not listed above (please inquire)
* This schedule is subject to change. Changes, if necessary, will be announced in class, e-mailed to distribution group, and updated here.
Please choose your session below based on your selection(s) above:*

Group Sessions - 10 one hour sessionsGroup Sessions - 20 one hour sessionsGroup Sessions - 30 one hour sessionsGroup Sessions Siblings - 10 one hour sessionsGroup Sessions Siblings - 20 one hour sessionsGroup Sessions Siblings - 30 one hour sessionsPrivate Sessions - 1 one hour session
* Promotional discount will be taken off the total price when siblings register.
Photo and Video Consent
For internal documentation and marketing purposes, photographs and videos may be taken while your child/children are participating in THE LAB Basketball training sessions. The images will remain the property of THE LAB Basketball and may be used by THE LAB Basketball to promote the program internally and externally including in social media and advertisements. I give / do not give my permission for my child/children to be photographed and videotaped by THE LAB Basketball appointed photographer and cameraman for the purposes of documentation and marketing purposes.*

YESNO
Electronic Waiver and Release of Liability
I am the parent/guardian of the child register herein. I hereby certify that my child/dependent that I am registering to participate in the THE LAB Basketball activities/programs does not have any pre-existing conditions, chronic illness, medical conditions, or injuries that would preclude him/her from participating. Sports participation requires an acceptance that an athlete may sustain a catastrophic injury and/or death. With this understanding, I hereby discharge, waive, and release THE LAB Basketball, its trainers, staff, and sponsors, from all liabilities or claims for damages or injuries and/or death that may be sustained or may occur by my child resulting from participation in THE LAB Basketball activities/programs.*

I have read and agree to the terms of the event waiver and disclaimer stated above
Parent/Guardian Signature*
Should be Empty:

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