PREP Prospect

Company

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Complete form in its entirety.

Player Name*

First Last

Why you would like to play for The Scoring Factory PREP?*

Current School/Team*

Current Grade*

DOB (date of birth)*

Height – feet*

Height – inches*

T-shirt size*

Weight (pounds)*

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Permission & Confidentiality

I certify that this information is true and complete to the best of my knowledge. I grant permission to The Scoring Factory to verify and share the information on this application with the coaching staff.

Name of Parent or Guardian*

First Last

Email*

Cell Phone*

Address*

Street Address City State ZIP Code

Current and desired position?

Basketball goals?

What does your current recruitment look like?

Provide links to games, stats and highlights

List all social media handles

List GPA and SAT/ACT scores

Liability Waiver

The undersigned, being an adult player, parent or legal guardian of the player, does hereby affirm that the player is in good health and free from any illness, disability or condition requiring regular medication other than those which have been disclosed and approved. The undersigned hereby grants permission to The Scoring Factory for use of pictures, images and video taken at camps, clinics, practices, games and workouts which may be used for promotional purposes. Outside video and still photography will not be allowed in the gym during private sessions or clinics. It is also requested that cell phones be put into silent mode during coaching sessions. In the event of accident or injury requiring immediate emergency treatment by professional medical personnel, the undersigned hereby gives consent to The Scoring Factory staff to procure any medical treatment deemed advisable on behalf of the player. The undersigned understands the benefit of getting a physical prior to intense physical activity and that they will be removed from action at the first signs of any head injury or concussion. Parents agree to educate their entire family with concussion-awareness material, such as the free “Head’s Up: Concussion in Youth Sports” program and by signing below acknowledge their support, comprehension, understanding and awareness. Players will be required to visit a licensed health care professional for an evaluation and clearance prior being allowed to return to participation and must present a signed statement to prove doctor’s approval. The undersigned hereby understands that they will be charged the full amount if they cancel a scheduled private training session with less than 24 hours notice. Additionally, there are no refunds for missed clinics, although a credit may be granted to a future program in extreme cases of illness or injury. The undersigned warrants that the player is fit to participate in rigorous physical activity and expressly represents the undersigned as the financially responsible party with regard to any and all medical costs, charges or fees incurred or resulting from the treatment of any and all illness or accident while under direct supervision of The Scoring Factory staff. The undersigned hereby releases The Scoring Factory, Pete Strobl, all facilities, all coaches and all staff members from any and all financial and legal liability associated with and/or arising from injuries or illness suffered by the player during participation in or with The Scoring Factory. The undersigned acknowledges that he/she has read and understands this liability waiver/emergency contact form and agrees to waive any rights, express or implied, under Pennsylvania State Law to recover any and all medical expenses from The Scoring Factory through court action, arbitration and/or any other legal means.

Acknowledgment*

I have read and agree to the terms. I certify that this information is true and complete to the best of my knowledge. I grant permission to The Scoring Factory to verify and share this informationwith the coaching staff.

Type Name*

Date*

Additional Comments

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