GYM RATS LITTLE TOTS SKILLS INSTRUCTION

GYM RATS LITTLE TOTS SKILLS INSTRUCTION ___ Back to School Session (Sept. 7 - Oct. 5, 2013 – Saturday mornings) – ENTRY DEADLINE IS SEPT. 4, 2013 ___ Fall Session (Oct. 12 - Nov. 9, 2013 – Saturday mornings) – ENTRY DEADLINE IS OCT. 9, 2013 ___ Pre-Winter Session (Nov. 16 – Dec. 14, 2013 – Saturday mornings) – ENTRY DEADLINE IS NOV. 11, 2013 ___ Winter Session (Jan. 4 - Feb. 1, 2014 – Saturday mornings) – ENTRY DEADLINE IS JAN. 1, 2014 ___ Spring Session (Feb. 15 - Mar. 15, 2014 – Saturday mornings) – ENTRY DEADLINE IS FEB. 12, 2014 The Fundamental and Skills Session will include the following items: 1. Ball handling and Dribbling 2. Passing 3. Shooting Technique 4. Defensive Fundamentals

Individual Registration Cost is $75.00 - Jerseys Provided Grade Level: Pre-K Kindergarten Please Circle: Boy or Girl

(Saturday mornings: 9:00am – 10:00am) Please Circle Uniform Size: S M L XL (YOUTH SIZES)

Participant’s Name: _____________________________

Age: _____

Birth date: ____/____/____

Parent’s Name: __________________________________ Address: ____________________________ City: ___________________ State: ____ Zip: ______________ Home Phone: _______________ Cell Phone: _______________ Email: _____________________________ Make Checks Payable to: GYM RATS INC. Send to:

Gym Rats Inc. P.O. Box 80640 Fort Wayne, IN 46898-0640

For UPS or Fed Ex:

5310 Merchandise Drive

ANY QUESTIONS PLEASE CALL: GYM RATS BASKETBALL OFFICE Phone: 260-471-5270

Fax: 260-471-3469

Website: www.gymratsbasketball.com or Email: [email protected]

Fort Wayne, IN 46825

Visa_____ MasterCard_____ Discover_____ Money Order_____ Cashier’s Check______ CC#__________________________________ Exp___________ Zip code Associated Card:___________ Name as it appears on card_________________________________ CV2 #____________ I, ______________________________ hereby give “Gym Rats” authorization to charge the following items and amounts. GYM RATS BASKETBALL Spiece Fieldhouse – 5310 Merchandise Dr. – Fort Wayne, IN 46825 – 260-471-5270 www.GymRatsBasketball.com

Participant, Team Representative, and/or Parents Release of Liability

PLEASE READ BEFORE SIGNING In consideration of being allowed to participate in any way in the camps, housing, tournaments, leagues and any other related activities (“Programs”) provided by or on the property of Gym Rats, LLC, Gym Rats, Inc., R.I. Spiece Sales, Inc. and Thomas Gene Spiece, the undersigned acknowledges, appreciates, and agrees that: 1.

The risk of injury from the activities involved in these Programs is significant, including the potential for permanent paralysis and death, and while particular rules, equipment and personal discipline may reduce this risk, the risk of serious injury does exist.

2.

I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of Gym Rats, LLC, Gym Rats, Inc., R.I. Spiece Sales, Inc. and Thomas Gene Spiece, their officers, officials, agents, representatives and/or employees, other participants, sponsoring agencies, sponsors, advertisers, (“Releases”), or others, and assume full responsibility for my participation.

3.

I willingly agree to comply with the stated and customary terms and conditions for participation. If however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and immediately bring such to the attention of the nearest official.

4.

I, for myself, and on behalf of any of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless Releases with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the Releasees or otherwise, to the fullest extent permitted by law.

5.

I, for myself, and on behalf of any of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless all of the above Releasees from any and all liabilities incident to my involvement or participation in these Programs, even if arising from their negligence, to the fullest extent permitted by law.

I AM AT LEAST EIGHTEEN (18) YEARS OF AGE AND I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. IF NOT EIGHTEEN (18) YEARS OF AGE – PARENT/GUARDIAN MUST SIGN

Participant’s Signature If not eighteen years of age – Parent/Guardian must sign

Parent/Guardian Signature

on behalf of Participant

Date

PLEASE PRINT: Player Name: _______________________________________ Address: __________________________________________________________________________________________ Zip ___________________________

Grade:_______

DOB:____________