Next Level Skills

Registration Form

Order Information

Player Name* :

Mailing Address* :

City* :

Birth Date* :

Please describe any known medical conditions :

Player Gender :

Home Phone* :

Day Phone* :

Province* :

Postal Code* :

Email* :

OHIP* :

Emergency Contact Information

Name* :

Home phone* :

Day Phone* :

Relationship* :

Basketball Training

Number of Sessions* :

Goals

Payment Method :

I hereby agree:TO WAIVE ANY CLAIM that I have against Next Level Skills and its agents.
TO RELEASE THE RELEASEES from any liability for loss, damage, injury or expense that I, or my child may suffer as a
result from participating in any Next Level Skills programs.
I also hereby authorize, in my absence, for Next Level Skills staff to seek medical attention in case of emergency.
I am physically fit to participate in the Next Level Skills programs; I am the legal or custodial parent of the
child named above.
I acknowledge that photos or video taken at Next Level Skills remain the sole property of Next Level Skills and may be used
for web or print marketing material.

I have read and understand this agreement

NOTE: Please make cheques payable to: Next Level Skills. Mailing address: 283 rue de la Galene, Gatineau, Quebec, J8Z 3P5