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Last Name

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Date of birth

Parent/Guardian 1 First Name

Parent/Guardian 1 Last Name

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Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email

Parent/Guardian 2 Phone

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Disclaimer: Must be checked for acknowledgement

I acknowledge that photos and videos taken at any Shake True Hoops / Ball4All events remain the property of Shake True Hoops / Ball4All. These photos may be used as promotional materials. I further acknowledge the inherent risks in sports and will not hold Stephen Cuevas, Shake True Hoops / Ball4All, or any staff/volunteers liable or responsible for any mishaps, injury or death resulting from participation in this program.

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