First Name *

Last Name *

Email *

Phone *

Player First Name *

Player Last Name *

Date Of Birth *

Player's Grade *

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Relationship *

Which days generally work best? *

Which time windows generally work best? *

Are there specific dates or scheduling limitations we should know about?

Player Goals *

What would you most like addressed during private training?

Assessment Notes

Current Injury or Limitation *

No

Yes

Injury or Limitation Details

Parent / Guardian Authorization *

Yes

Participation Waiver Accepted *

Yes

Emergency Medical Authorization *

Yes

No

Private Training Terms Acknowledgment *

Yes

I understand that private-training credits are purchased as one-time credits, are subject to availability and expire according to the package purchased. A session canceled or rescheduled with fewer than 24 hours’ notice may use one training credit.

Cancellation Policy Acknowledgment *

Yes

A session may be canceled or rescheduled without losing the credit when at least 24 hours’ notice is provided.A cancellation made less than 24 hours before the session will result in the session credit being used. A missed session or no-show will also result in the credit being used.Emergency exceptions may be approved at Born 2 Hoop’s discretion.

Photo and Video Permission *

Yes, I grant permission

No, I do not grant permission

May Born 2 Hoop photograph or record the player during programs and use that content for coaching, educational, website, social media, advertising and promotional purposes?

Operational SMS Consent

Yes

I agree to receive non-marketing text messages from Coach Kevin and Born 2 Hoop concerning this request, scheduling, appointment reminders and service updates. Message frequency may vary. Message and data rates may apply. Reply HELP for assistance or STOP to opt out

Marketing SMS Consent

Yes

I agree to receive recurring marketing and promotional text messages from Born 2 Hoop, including program announcements, registration opportunities and special offers. Consent is not a condition of purchase. Message frequency may vary. Message and data rates may apply. Reply HELP for assistance or STOP to opt out.

Parent/Guardian Electronic Signature *