REGISTRATION FORM | THE PENNY WAY, LLC

NAME *

M/F *

ADDRESS *

PHONE NUMBER *

EMAIL ADDRESS *

SCHOOL *

GRADE *

T-SHIRT SIZE *

YS
YM
YL
YXL
AS
AM
AL
XL
2XL

EMERGENCY CONTACT/RELATIONSHIP *

EMERGENCY PHONE *

PREFERRED HOSPITAL *

MEDICAL CONDITIONS *If your child has any additional medical needs, please bring this to the attention of the instructors *

DATE / LOCATION *

CAMP: 6TH-8TH GRADE (LOGANSPORT) APRIL 18TH
CAMP: K-2ND GRADE (LOGANSPORT) MAY 2ND
3 DAY CLINIC: 3RD-8TH GRADE (KOKOMO) JUNE 1ST-3RD
TRANING CLINIC: GRADES 3RD-12TH (LOGANSPORT) JUNE 28TH

TIME *

9A-1P (6TH-8TH GRADE)
9A-12P (K-2ND GRADE)
9A-12P (3RD-8TH GRADE)
9A- 1030A ITRAIN CLINIC (3RD-8TH GRADE)
11A-1230P ITRAIN CLINIC (6TH-8TH GRADE)
1P-230P ITRAIN CLINIC (9TH-12TH GRADE)

Agreement, Waiver and Release for Minor

I acknowledge that participating in The Penny Way Basketball Program involves inherent risks, including the possibility of injury. Therefore, I authorize the staff of The Penny Way Basketball Program to make decisions in my son’s/daughter’s best interest should any medical emergencies arise. I release and hold harmless The Penny Way Basketball staff, coaches, and volunteers from all claims related to personal injury. Additionally, I will be responsible for any medical expenses or charges incurred during my child’s participation in the program. I give my consent for photographs of my child to be taken, understanding that these images may be used by The Penny Way Basketball Program. I affirm that I am at least eighteen years old and confirm that my child is physically fit and has no known medical conditions that would prevent participation in this sport. I have read this waiver and agree to its terms.

PARENT/GUARDIAN SIGNATURE *

Once you have submitted your registration, please navigate to the 'Player Fees' tab to complete your payment. This step is essential to finalize your registration. Thank you!