Child's name *

First Name

Last Name

Parent/Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Photo Release *

May we use your child's image on social media and our website?

yes.

no.

Waiver of Liabilty *

I hereby assume all of the risks of participating in the Salem 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 Hoops Project in which my chlid 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.

Acknowledge