Sign-Up Sign-Up Form main-signup-radio-buttonsNew PlayerMemberSibling discounts available only to Members and to siblings enrolled in identical program(s).Clinic, Program or Event*Select ProgramNew JerseyWaiver OnlySelect Team EvaluationIQ LeagueSpecialty Clinic(s)Financial Aid RequestConsultationGame EvaluationNJ Create & Stopper*Create: Single Session $35Stopper: Single Session $35Both Programs: Single Day $45Create: Entire 7-weeks: $100Stopper: Entire 7-weeks: $100Both Programs: Entire 7-weeks: $150(Sunday clinic)Select Team Evaluation*Select Team Evaluation $20Specialty Clinic(s)*TBA - Chatham $20Gold Member $0Propel Clinics*All 4 sessions $149Propel Clinics*All 4 sessions $99Accelerator Evaluation(s)*Boys - $35Boys - Gold Member $0Girls - $35Girls - Gold Member $0USC Clinic(s)*Boys Sep 29th - $20Boys Oct 6th - $20Boys Sep 29th & Oct 6th - $35Boys - Gold Member $0Girls Sep 29th - $20Girls Oct 6th - $20Girls Sep 29th & Oct 6th - $35Girls - Gold Member $0King & Handles*King: Single Session $35Handles: Single Session $35Both Programs: Single Day $50King: Both Days: $65Handles: Both Days: $65Both Programs: Both Days: $95(Sunday morning clinic)King & Handles - Members*King: Single Session $30Handles: Single Session $30Both Programs: Single Day $40King: Both Days: $55Handles: Both Days: $55Both Programs: Both Days: $75(Sunday morning clinic)IQ League*Moon $225IQ League - Members*Moon $150Consultation*Phone Consultation $125In-Person Consultation $150Follow-Up Phone Consultation $75Follow-Up In-Person Consultation $100Consultation - Members*Phone Consultation $100In-Person Consultation $125Follow-Up Phone Consultation $50Follow-Up In-Person Consultation $75Game Evaluation*Game Evaluation $175Game Evaluation - Members*Game Evaluation $150Please share why you are applying for financial assistance:Financial Status & ConfidentialityI certify that this information is true and complete to the best of my knowledge. I grant permission to The Scoring Factory to verify this information and agree to notify The Scoring Factory if my financial status should change.I understand that information may be needed to verify eligibility for this program and to coordinate services with other agencies. Therefore, I agree that agencies may share my child’s information. I certify that the information supplied is true and correct and that NCS staff have my permission to verify the information on this application. I understand that my child’s participation in this program requires a commitment to attend a minimum of 80% of the scheduled practices and games.Player Name* First Last School or Team*Grade*Select Grade123456789101112PrepCollegeProDOB (date of birth)* Date Format: MM slash DD slash YYYY T-shirt size*Select T-Shirt SizeYouth SYouth MYouth LYouth XLAdult SAdult MAdult LAdult XLAdult XXLHeight - feet*Select Height (feet)34567Height - inches*Select Height (inches)01234567891011Sibling Click to add a SiblingNJ Create & Stopper - Sibling*Create: Single Session $20Stopper: Single Session $20Create & Stopper: Single Day $30Create: Entire 7-week Program $50Stopper: Entire 7-week Program $50Create & Stopper: Entire 7-week Program $75(Sunday clinic)IQ League - Member Sibling*Franklin Regional $100Moon $100(Sunday evening clinic)Pick'n'Roll & Form - Member Sibling*Pick'n'Roll: Single Session $20Form: Single Session $20Pick'n'Roll & Form: Single Day $30Pick'n'Roll: Entire 7-week program $75Form: Entire 7-week program $75Pick'n'Roll & Form: Entire 7-week program $125(Sunday morning clinic)King & Handles - Member Sibling*King: Single Session $20Handles: Single Session $20King & Handles: Single Day $30King: Entire 7-week Program $40Handles: Entire 7-week Program $40King & Handles: Entire 7-week Program $55(Sunday morning clinic)Academy - Member Sibling*Evaluation: FreeFull Academy: Single Payment: $595Full Academy: Two Payments: $325Full Academy: Monthly Payments: $175Half Academy: One Payment: $325Quarter Academy: Single Payment: $175Player Name - Sibling* First Last Grade - Player 2123456789101112PrepCollegeProDOB - Player 2* Date Format: MM slash DD slash YYYY T-shirt size - Player 2Youth SYouth MYouth LYouth XLAdult SAdult MAdult LAdult XLAdult XXLName of Parent(s) or Guardian(s)* First Last Email* Phone*Alternate PhoneAddress Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Emergency Contact* First Last Emergency Contact Phone*Name of Doctor First Last Doctor PhoneWhy do you want to train with us?What are your goals and objectives?What are your current strengths and weaknesses?What teams have you previously played for?Please list any online links to stats and videos on YouTube.Liability WaiverThe undersigned, being a 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, practice 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.Parent/Guardian Acknowledgment* I have read and agree to the terms.Type Name*Date Date Format: MM slash DD slash YYYY Additional CommentsHow Did You Hear About Us?Clinic, Program or Event - Player 2*FinishShooterFinish AND ShooterZeke Camp 2016Overachiever Camp 2016PowerExplosivePower AND ExplosiveSlasherBall-SkillsSlasher AND Ball-SkillsTotal $0.00 Payment Options:*Credit CardMail a CheckIn PersonNJ Payment Options:*Mail a CheckIn PersonMake payable to The Scoring Factory and send to our mailing address:The Scoring Factory 1735 E. Carson Street #303 Pittsburgh, PA 15203Credit CardAmerican ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code (on AMEX cards, is on front) Cardholder Name Join our mailing list?Yes, I would like to subscribe.Not at this time.NameThis field is for validation purposes and should be left unchanged.