Collegiate Prep Basketball Academy Form

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Davis Academy 2012

Last Name:
First Name:
Birthday:	Age:
Address:
City:
State:	Zip:
Phone Number:
School:
Grade:
Gender:
Parent's Name:
Parent's Email:
Alternate Email:
Alternate Email 2:
Cell Phone:	Cell Phone 2:
Insurance Company:
Insurance Policy Number:
Medical Concerns (if any):
Emergency Contact Name:
Phone:
Relationship:
Division:

I give my son/daughter permission to participate in the Davis Academy Basketball Program.

I hereby grant permission to Collegiate Prep Basketball Academy to have my child treated by a physician if necessary and waive any and all liability or any costs associated from any injuries that may occur involved with the participation of camp.

I agree to allow Collegiate Prep Basketball Academy to use my child’s photograph and likeness on any website, brochures, or other promotional materials.

By submitting this form, I agree to the waiver and liability clauses. This has legal standing as if it where your signature.

I agree to the above statements

All basketball information is proprietary and protected by US copyright laws. Any attempt to steal, copy, duplicate, disseminate, distribute transfer or reproduce copyrighted ideas, terms, drills, organizational materials or other league or instructional information for monetary gain or in competition of the CPBA is a direct violation of US law and subject to prosecution under the law. This includes coaches, camp directors, parents, or player representatives/agents recruiting players for the direct purpose of creating their own teams, training programs, camps, etc.

In registering my child I fully understand and agree to the above terms.

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