Participant's Full Name
Date of Birth
Address Line 1
Address Line 2
Parent Guardian's Full Name
Emergency Contact's Name
Emergency Phone Number
Does your child have any illness/medical conditions he/she is currently being treated for?
If yes, what?
Is he/she currently taking medications?
(1) Medication, Dosage & Frequency
(2) Medication, Dosage & Frequency
(3) Medication, Dosage & Frequency
Does your child have any allergies?
If yes, please list.
LIABILITY: I am aware that participation in training sessions, camps, and/or all DB Hoops related activities has some inherent risks and injury can occur. On rare occasions these injuries can be serious. In consideration of my child being allowed to participate in these activities, I, the parent/guardian, assume the risk of all injuries and agree not to sue the Dream Big Center, Inc., directors, coaches, assistant coaches, or volunteers for any and all injuries caused by or resulting from participating in training sessions, camps, and all DB Hoops related activities. Your signature below gives the Dream Big Center, Inc. permission to seek medical care for your child and/or transport your child to/from medical facility and to share this information with medical personnel on your child’s behalf in case of an emergency.
PHOTO/VIDEO CONSENT: By signing this waiver, I also authorize the use of images of the above-named participant captured through video, photo, and digital camera, and/or audio to be used, reproduced, and/or published by the Dream Big Center, Inc. on website or advertising. I waive any rights of compensation or ownership to materials used, reproduced, and/or published pertaining to the image, likeness and/or voice of my child by the Dream Big Center, Inc.
EXPECTATIONS: All student athletes are expected to give their full mental, physical, and emotional attention and effort during training sessions, camps, and all DB Hoops related activities. Silence, attention, and active learning are required during all instructions given. As a representation of the Dream Big Center, Inc., respect and sportsmanship are demanded during all activities.