Portland Holiday Clinic

Monday, December 23, 2019
9:00 AM 1:00 PM 09:00 13:00

Warner Pacific College United States (map)

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The first ever Portland Hoops Project clinic will be on Monday, December 23rd led by DJ Shaw. Clinics are free to boys and girls and will be at Warner Pacific College

Session 1: 4th-6th grade

9-11 AM

Session 2: 7th-8th grade

11 AM- 1 PM

For more info contact djshaw503@gmail.com

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Child Name

First Name

Last Name

School Name

Grade

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Email

Parent Guardian Phone

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Waiver of Liabliity

I hereby assume all of the risks of participating in the Salem/Portland Hoops Project basketball clinics, Including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them, or because of their possible liability without fault. I certify that my child(s) is physically fit and has not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my child's participation in the clinics. I acknowledge that this Accident Waiver and Release of Liability Form will be used by the Salem/Portland Hoops Project and the Warner Pacific College facilities in which my child may participate and that it will govern my actions and responsibilities. In consideration of my application and permitting my child(s) to participate in the clinics, I hereby take action for myself, my executors, administrators, heirs, next of kin, and successors.

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