Spring Break Basketball Skills Clinic - Registration

athlete's name *

First Name

Last Name

registration dates

Monday, February 25

Tuesday, February 26

Wednesday, February 27

Thursday, February 28

Friday, February 29

Monday - Friday (entire week)

parent/guardian name *

required for ages 17 and under

First Name

Last Name

phone number *

parent or guardian phone

(###)

###

####

emergency contact *

Please list a second contact, the person who is listed as a guardian/parent will be contacted first in the case of an emergency, this is a secondary contact in case we can not get in touch with the parent/guardian. Must be 18 or older.

First Name

Last Name

emergency contact phone *

(###)

###

####

registration options

$50 - one clinic - I authorize Life Time to run my membership dues credit card

$100 - two clinics - I authorize Life Time to run my membership dues credit card

$150 - three clinics - I authorize Life Time to run my membership dues credit card

$200 - four clinics - I authorize Life Time to run my membership dues credit card

$225 - full week - I authorize Life Time to run my membership dues credit card

Life Time Policies *

Please acknowledge the following agreements: Assumption of Risk, Waiver of Liability and Indemnification. I understand and agree that the Program(s) which I have purchased with this Agreement involve the risk of injury and I elect to participate in the Program(s) voluntarily in spite of the risk. I further understand and agree that the terms of my General Terms Agreement and Member Usage Agreement continue to apply, including the assumption of risk, waiver of liability and indemnification provisions contained therein. Cancellation for Medical Reasons. For medical disabilities, a prorated refund or credit will be given when participant provides a doctor’s note stating participant can no longer participate in program. Personal Information and E-mail. I understand that by providing my email address, I consent to receiving both membership related and commercial email messages from Life Time and Ultimate Hoops. Release of Image and Likeness. I hereby irrevocably consent to and grant Life Time Ultimate Hoops the exclusive and un-limited right to use and reproduce any and all photographs, audio recordings, video recordings or testimonial accounts taken by Life Time that contain my person, name, image, voice, likeness or account, for any lawful purpose whatsoever and using any means available including, but not limited to, any Life Time corporate or marketing communication or material. I further understand that Ultimate Hoops posts to uhlife.com and other social media networks and any posts will be visible to the public. I waive the right to inspect, approve or edit any such use or reproduction, and Life Time may make any and all changes, modifications, rearrangements, additions or deletions in its use or reproductions without any approval.

I have read this Agreement thoroughly, understand all of its terms including the Cancellation Policy, received a copy if I request it, and have knowingly and voluntarily signed it.