Full Name (Parent or representative)

Phone *

Email *

Address

Street Address

City

State

Country

Postal Code

Full Name (PLAYER)

Date of birth (PLAYER)

Age (PLAYER)

Height (PLAYER)

Weight (PLAYER)

Grade (PLAYER)

Current academic average

Previous Basketball Experience?

YES

Does your child stay on top school responsibilities?

Does your child have any medical condition, allergy, previous injury or physical restriction that we should know for their safety?

Are you authorized by a doctor perform physical activity without restrictions?

YES

How would you describe your child's behavior in group activities?

Additional Emergency Contact

Full Name
Relationship
Phone

Do you commit to supporting your child's puntual attendance at practice and games?

YES

Do you agree to maintain open communication with the Kallpa coaches regarding the athlete's progress?

YES

What do you expect your child to develop at Kallpa Hoops?

This is a recurring monthly membership. Payments are automatically processed every month until canceled.

IMPORTANT NOTICE – LIABILITY WAIVER & AGREEMENT Please read this agreement carefully before submitting. This agreement is entered into in consideration of the training, coaching, and services provided by Kallpa Hoops LLC, including its coaches, staff, volunteers, employees, and representatives (collectively referred to as “KALLPA HOOPS LLC”). By submitting this form, I acknowledge and agree to the following on behalf of myself, my child, and my family: 1. ASSUMPTION OF RISK I understand that participation in basketball-related activities—including but not limited to training sessions, conditioning, drills, games, scrimmages, and tournaments—involves inherent risks. These risks may include minor injuries such as sprains, bruises, muscle soreness, and in rare cases, more serious injuries. I acknowledge that while KALLPA HOOPS LLC takes safety seriously, it is not possible to eliminate all risks without altering the nature of the sport. I voluntarily and knowingly assume all risks related to my child’s participation. 2. MEDICAL RESPONSIBILITY I understand and agree that I am solely responsible for any medical expenses incurred as a result of my child’s participation in activities organized by KALLPA HOOPS LLC. 3. RELEASE AND WAIVER OF LIABILITY To the fullest extent permitted by Florida law, I hereby release, waive, and hold harmless KALLPA HOOPS LLC, its owners, officers, staff, coaches, volunteers, and representatives from any and all claims, demands, injuries, damages, or liabilities arising out of or related to participation in academy activities. This release does not apply in cases of gross negligence or intentional misconduct. 4. MEDICAL AUTHORIZATION In the event of a medical emergency, I authorize KALLPA HOOPS LLC staff to obtain necessary medical treatment for my child. I understand that reasonable efforts will be made to contact me prior to seeking such treatment; however, I authorize medical care if immediate action is required. 5. MEDIA RELEASE I grant KALLPA HOOPS LLC permission to photograph, video record, or otherwise capture my child’s image and likeness during academy activities. I authorize the use of such media for academy-related purposes, including but not limited to social media, websites, marketing materials, and promotional content. I understand that no financial compensation will be provided. If I wish to revoke this permission, I may do so by submitting a written request to: [email protected] 6. ACKNOWLEDGMENT AND ACCEPTANCE I acknowledge that I have read and fully understand this agreement. By submitting this form electronically, I confirm that I voluntarily accept all terms and conditions outlined above. I understand that my electronic signature is legally binding and has the same legal effect as a handwritten signature. *

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