2019 Billy Taylor Basketball Academy

2019 Billy Taylor Basketball Academy Registration

Session *:

General Player Information

First Name *:     Last Name *:


Height *:     Weight *:     Age *:

Address *:

City *:     State *:     Zip Code *:

Parent Name *:
Parent Email *:
Parent Cell Phone *:
Camper Cell Phone:
Camper Email:

Player Information School Name *:    
Grade (Fall 2019) *:
Primary Position *:
T-Shirt Size:

Club Team:
Emergency Information

Allergies *:

Known Medical Condition(s) *:

Insurance Carrier *:    
Policy Number *:
Emergency Contact Name *:     Relationship *:
Emergency Contact Day Phone *:
Emergency Contact Evening Phone *:

* denotes required fields

This is a legally binding release for the above named Minor child (hereinafter referred to as "Participant") executed by the above named Parent or Guardian to Billy Taylor Basketball Academy (hereinafter referred to as "BTBBA"). In this agreement, the terms "I" and "Undersigned" refer to the Participant's parent or guardian. 1.0: The Undersigned herby grants permission to Participant to participate in the BTBBA at Belmont Abbey College in the summer of 2016 ("activity"). The Undersigned further grants permission for Participant to stay overnight in a residence hall (if applicable) for the duration of the camp session. 2.0: In consideration of the Participant being permitted to participate in the activity, the Undersigned releases BTBBA (its employees and agents) from any and all liability, claims and actions not arising from Belmont Abbey's casual negligence, that may arise from injury or harm to the Participant or from loss or damage to any property belonging to the Undersigned in connection with this activity. The Undersigned grants permission despite the possible dangers and risks, and despite this Release. The Undersigned understands that BTBBA does not require the Participant to take part in the activity. 3.0: The Undersigned submits that Participant is physically able to participate in the Activity. In the event of an emergency, the Undersigned grants permission to BTBBA to administer first aid and/or obtain emergency medical treatment for the Participant. The Undersigned agrees to pay all expenses incurred due to any emergency involving Participant in conjunction with the Activity. 4.0: The Undersigned therefore agrees to assume and take on all of the risks, except for those risks specifically created by the casual negligence of BTBBA, in any way associated with the Activity. The Undersigned also understands that this Release binds heirs, executors, administrators, and assigns of the Participant. I have read this entire Release; I fully understand it and I agree to be legally bound by its terms. 5.0: The Undersigned grants permission to BTBBA to utilize Participants photograph, image, audio and/or video recording which is created by BTBBA during Participant's participation in the Activity.

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