Welcome to The Checkup with Spencer Levy!

This registration session will allow you to complete contact information, sign up for participation, and submit payment.

Please read through each page carefully to ensure that all information is provided accurately.

To complete registration through our secure site, please have your Visa or MasterCard information available.

First Name *

Last Name *

Date Of Birth *

Gender *

Male

Female

Grade/Year *

Please specify player's skill level *

Position *

Parent/Guardian First Name: *

Parent/Guardian Last Name: *

Parent/Guardian Phone Number: *

Parent/Guardian Email: *

Do You Have Any Medical Conditions or Allergies? *

How did you hear about us?

AGREEMENT, WAIVER, AND RELEASE

1, the parent/guardian/participant, in registering with Up Your Performance Basketball, understand that he/she in attending the eventfor Up Your Performance Basketball and using the facilities does so at his/her own risk. I acknowledge that I am aware of the risksinherent in participating in basketball; both practice and competition; that basketball is a physical sport, which can requireconsiderable running and physical exertion; and responsibility for all injuries and damages, which may occur in or at any Up YourPerformance Basketball event. He/she/l do or does hereby fully and forever release, discharge and hold harmless Spencer Levy, Up Your Performance Basketball, Carlos Jimenez, organizers, employees, sponsors, and agents from any and all claims, damages, rights of action, property loss, present or future resulting from or arising out of any person's participation. In addition,he/she/l agree(s) to follow rules of play and conduct set by Up Your Performance Basketball and the gym sites. He/she/l understand(s)that failure to do so may result in suspension from participation. Up Your Performance Basketball has a NO Refund Policy.

Signature

Clear

Questions

Please direct any questions regarding this registration to:

UYP Customer Support: (949) 430-7516 | www.upyourperformance.org