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On-Line Registration Form

* All fields are required to complete registration

Full Name:
I am a:
Student-Athlete:
Parent:
Coach:
School/Team/Organization:
Coach's Name:
Age:
Grade:
Sport of Interest:
Address:
City:
State:
Zip:
Cellular Number:
Email:
Workshop Selection 1
Workshop Selection 2
Workshop Selection 3
Workshop Selection 4

NOTE: Please select one workshop from each section. You will be registered for three of your four top selections. Once you are registered for the workshops you are automatically registered for entrance into the basketball game.

Parental Consent (if participant is under age 18)

By submission of this registration, I am herby allowing my child to participate in the Running the Point for Pink event on Saturday, October 24, 2009 from 8:30am-5:00pm at Central High School located at 246 18th Avenue, Newark, NJ. My child has permission to take part in all of the workshops, activities, game and receive meals.

Consent for Photographs/Video

I give permission for photographs/video footage to be taken of the participant, and for photographs/video footage in which the participant is included to be used for purposes of publicity by the Satori Athletic Organization (SAO) (non-profit programs), this includes publication of pictures on brochures, website, and/or promotional display boards.

Release, Waiver, and Indemnification

I do hereby execute this release, waiver, and indemnification and agree to the release of the Satori Athletic Organization and their officers, employees, volunteers and agents from any and all liability, loss, damage, costs, claims or causes of action including, but not limited to bodily injuries and property damages arising out of the sole negligence of the Satori Athletic Organization.

Parent/Guardian Name:
Relationship:
Address:
City:
State:
Zip:
Cell Phone:
E-Mail: