Basketball Clinic - Momentum Youth Sports Training

Athlete's Name *

First

Last

Athlete's Date of Birth *

MM/DD/YYYY

Parent/Guardian's name *

First

Last

Parent/Guardian email *

Parent/Guardian phone *

Address

Address Line 1

Address Line 2

City

State

Zip Code

you Credit Card

Please list any medical conditions/concerns.

We film and videotape our sessions. Do you give permission for your child's photos/videos to be used for promotional purposes?

Yes
No

Consent and Liability Waiver *

I agree and give my permission

I, the undersigned, am the parent/guardian of the participant named below. I hereby give my consent for my child to participate in the Back to Basics Basketball Camp organized by Momentum Youth Sports Training.
I acknowledge that participation in the basketball activities involves inherent risks, including but not limited to injury, and I assume all risks associated with my child’s participation. I release and hold harmless Momentum Youth Sports Training, its coaches, staff, volunteers, and any affiliated entities from any and all claims, liabilities, or damages arising from my child’s participation in the camp.
In case of illness or accident, I authorize emergency treatment by qualified medical personnel and permit the person in charge to take my child to seek necessary medical care. I consent to the facility securing all required emergency medical care for my child.
By signing, I confirm that I have read and understood this consent and liability waiver.

Signature

Clear Signature

Payment Method *

Credit Card – $20.00
Venmo (@Momentum-Youth-Sports) – $20.00
PayPal (mwilds@momentumyouthsports.org) – $20.00

Stripe Credit Card

Card

Name on Card