Total Player Clinic Registration Pennfield | Hoop Dreams with Chris Herren

Total Player Development Clinic - Pennfield

Player Information:

Player Name (required)

Address (required)

City (required)

State (required)

Zip Code (required)

Contact Phone (required)

Email (required)

Player's Age (required)

Player's Grade/School (required)

Clinic Session

Medical Information:

Allergies / Medical Conditions (required)

Doctor (required)

Doctor's Phone (required)

Insurance Company (required)

Insurance Policy # (required)

Emergency Contact (required)

Relationship (required)

Emergency Contact Phone (required)

Waivers: (Please Check Boxes)

Parental Release and Consent

I hereby give approval for the participation of my child in Hoop Dreams with Chris Herren Clinics and Camps and I assume all risk and hazards incident to such participation including transportation to and from said activities. I/We waive, release, absolve, indemnify, defend and agree to hold harmless Hoop Dreams with Chris Herren, Inc., the organizers, the officers, the board of directors, participants, officials, and persons from such activities form any claims arising out of injury to my child.

Medical Release and Permission

I/We do hereby authorize any person in a responsible position within Hoop Dreams with Chris Herren, Inc., in the event of an emergency, to authorize emergency medical treatment for my child named herein. I/We agree to hold harmless such persons and such emergency care centers for such act and agree to assume financial responsibility for said treatment.

Photo/Participant Waiver

I hereby give approval for Hoop Dreams with Chris Herren, Inc. to use photos and/or the name of my child for and in promotional and advertising materials. Additionally, I grant approval to Hock Films, Inc. to photograph and record my child in certain audiovisual footage (the "Footage"), Hock Films, Inc. and/or anyone working under its direction may photograph, film, videotape, record and otherwise use and exploit my name, voice, biographical information, and portrait and likeness, including without limitation, any statements, interviews or performances of me, whether as contained in existing photography or as photographed by Hock Films, Inc., collectively, "Name and Likeness" in the Footage. I further agree that Hock Films, Inc. may publish, display, distribute and otherwise exploit the Footage and/or Name and Likeness (including without limitation in or as part of any advertising, promotion, publicity, and/or works of any kind or nature. I acknowledge that neither Hock Films, Inc. nor any other entity shall be required to provide me with any compensation of any kind for the rights I am granting herein.

Payment Method (required)