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Pre K Intro to Basketball - 2023
Thursday Pre K Basketball Clinics @ Shooting Lab in Ridgewood (First Pres Church)
Player Information
First Name
Last Name
Gender
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M
F
Parent Contact
Relationship to Participant:
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Mother
Father
Guardian
Clinics 2023 - Pre K Goats Basketball Clinic
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Intro to Basketball Thursdays Winter 2023 @ 4:30 pm (Prorated $186.75)
March Madness Pre K Clinic ($199)
First Name
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Last Name
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Address 1
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Address 2
City
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State
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Zip
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Cell Phone
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Alternate Phone
Email Address
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Additional Info?
WAIVER: I hereby authorize the staff of SHS LLC to act for me according to their best judgment in any emergency requiring medical attention for my child, if I cannot be contacted. In consideration of acceptance of my child, I hereby for myself, my child, theirs heirs, executors and administrators hold harmless, waive and release any claim we may have for damages against the above mentioned organizations, camp operators, their officials, officers, employers or representatives, or their successors and assigns for any and all injuries that may be suffered. I certify that I am parent/guardian of above participant and I am over the age of 18 years. I further agree that the above named parties are under the obligation to provide a physical examination or other evidence of a child's fitness to participate in this program, the same being my sole responsibility. I attest that my child is in sound condition to participate in all activities. I understand by signing this waiver any or all refunds will come in the form of credit. SIGN BELOW:
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ALL REFUNDS COME IN THE FORM OF CREDIT.
COVID-19 WAIVER
:
Due to the outbreak of the novel Coronavirus (COVID-19), SHS LLC is doing everything we can to protect you, our clients, our community and our staff. To this extent, SHS LLC will be following the Center of Disease-Control (CDC) guidance with regard to social distancing practices and sanitation. We ask that our clients disclose their health history and continue to implement these sanitation and disinfection procedures.
Symptoms of COVID-19 include:
• Fever
• Fatigue
• Dry Cough
• Difficulty Breathing I agree to the following: *
I, nor members of my household, have not experienced any of the symptoms listed above within the last 14 days.
I, nor members of my household, have not travelled internationally in the last 30 days.
I, nor members of my household, have not traveled to a highly impacted area within the United States of America is the last 30 days.
I, nor members of my household, do not believe that we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus (COVID-19).
I, nor members of my household, have not been diagnosed with the Coronavirus (COVID-19) within the last 30 days.
I, nor members of my household, do not believe that we have been exposed to someone with a suspected and/or confirmed case of the Coronavirus (COVID-19)
with the exception of certified healthcare workers caring for patients adhering to appropriate safety measures including personal protective equipment, etc.
SHS LLC cannot be held liable from any exposure to the Coronavirus (COVID-19) caused by misinformation on this form or the health history provided by each client. If I take any steps to make a claim for damages against SHS LLC, its agents, employees or any other released parties, I shall be obligated to pay all attorney’s fees and costs incurred as a result of such claim SHS LLC is following these enhanced procedures to prevent the spread of the Coronavirus (COVID-19) By signing below, I hereby release and agree to hold SHS LLC harmless from and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses, and compensation for damages or loss to myself and/or property that may be caused by any act, or failure to act of the LLC, or that may otherwise arise in any way in connection with any services received from SHS LLC. I agree to release SHS LLC from any and all liability for the unintentional exposure or harm due to the Coronavirus (COVID-19) SHS LLC agrees to abide by these standards and affirms the same.
SIGN BELOW:
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