Participant Registration & Liability Waiver

1 — Participant Information

First Name *

Last Name *

Date of Birth *

Gender

Age Group

Program / Season *

Street Address *

City *

State

ZIP

Phone Number

Email Address *

2 — Emergency Contact

Contact Name *

Relationship *

Phone (Primary) *

Phone (Alternate)

3 — Health Insurance Verification

Hoop Vision requires all participants and/or their parents/guardians to carry personal health insurance. This program does not provide primary health coverage for participants.

Does the participant carry personal health insurance? *

Yes No

Insurance Carrier

Policy / Member ID

Group Number

4 — Medical Information

Known medical conditions, allergies, or physical limitations?

Has the participant ever sustained a concussion or head injury?

Yes No

If yes, provide date and brief description

5 — Concussion Education Acknowledgment

By signing this form, you acknowledge receipt and review of Hoop Vision's Concussion Awareness & Management Program. Key points are summarized below.

What is a concussion? A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or body that causes the brain to move rapidly. Concussions can occur even without loss of consciousness.

Signs & symptoms to watch for: Headache or pressure in the head, nausea or vomiting, balance problems or dizziness, double or blurry vision, sensitivity to light or noise, feeling sluggish, foggy, or groggy, difficulty concentrating or remembering, confusion, or mood changes.

Immediate response policy: If a concussion is suspected, the participant will be removed from activity immediately and will not return to play that day under any circumstances.

Return-to-play policy: A participant who has suffered a concussion may only return to activity after: (a) at least 24 hours have elapsed from the time of injury, AND (b) written clearance from a licensed physician has been provided to program staff.

Prevention: Proper technique, respectful play, and reporting all head impacts promptly are the best preventions. Participants are encouraged to report any symptoms to a coach or staff member immediately.

I have read and understand the Concussion Awareness summary above and acknowledge receipt of Hoop Vision's full Concussion Protocol. *

6 — Waiver & Release of Liability

I, the undersigned participant (or parent/legal guardian of the minor participant named above), understand and acknowledge that participation in basketball and related athletic activities organized by CodePoint Capital LLC d/b/a Hoop Vision ("Hoop Vision") involves certain inherent risks, including but not limited to physical injury, property damage, and in extreme cases death.

In consideration of being allowed to participate in Hoop Vision programs, camps, clinics, leagues, and related activities, I, on behalf of myself and/or my minor child/ward, voluntarily agree to the following:

Assumption of Risk: I acknowledge and accept all risks associated with participation in sports and athletic activities, including but not limited to falls, collisions with other participants or equipment, overexertion, and environmental conditions.

Release of Liability: I hereby release, waive, discharge, and covenant not to sue CodePoint Capital LLC d/b/a Hoop Vision, its officers, directors, employees, volunteers, coaches, agents, and contractors (collectively "Released Parties") from any and all liability, claims, demands, or causes of action arising from participation in Hoop Vision programs, to the fullest extent permitted by applicable law.

Indemnification: I agree to indemnify and hold harmless the Released Parties from any loss, liability, damage, or cost incurred due to my participation or my minor child's participation in Hoop Vision programs.

Medical Authorization: In the event of an injury or medical emergency, I authorize Hoop Vision staff to seek and consent to emergency medical treatment on behalf of the participant named above. I understand I am responsible for all medical costs incurred.

Photo/Media Release: I grant Hoop Vision permission to use photographs, videos, or other media taken during program activities for promotional, educational, or operational purposes without compensation.

I have read this Waiver and Release in its entirety, understand its terms, and sign it voluntarily. I confirm that I am of legal age or am the parent/legal guardian of the minor participant.

I have read, understand, and agree to the Waiver & Release of Liability above. *

7 — Signatures

Participant Signature (if 18 or older)

Full Name (Print) *

Date *

Signature (type full name to sign electronically)

For participants under 18: A parent or legal guardian must complete the section below. By signing, the parent/guardian confirms they have read and agreed to all terms on behalf of their minor child.

Parent / Legal Guardian Signature (required for participants under 18)

Parent / Guardian Full Name *

Relationship to Participant *

Parent / Guardian Phone *

Parent / Guardian Email *

Signature (type full name to sign electronically) *

Date *