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Beyond Ball Series Registration Form

* All fields are required to complete registration

Student Name:
School/Team/Organization:
Age:
Grade:
Sport of Interest:
Address:
City:
State:
Zip:
Telephone:
Email:

Parental Consent

By submission of this registration, I am herby allowing my child to participate in the Beyond Ball Series for Aspiring Athletes on Sunday, October 5, 2008 from 8:30am-3:00pm at Science Park High School located at 260 Norfolk Street, Newark, NJ. My child has permission to take part in all of the workshops, activities, and receive meals.

Consent for Photographs/Video

I give permission for photographs/video footage to be taken of the particia sport pant, and for photographs/video footage in which the participant is included to be used for purposes of publicity by the Satori Athletic Organization (SAO), and Tribeca House (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 and Tribeca House Organizations and their officers, employees, 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 and/or Tribeca House.

Parent/Guardian Name:
Relationship:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone: