NBBA FACILITY
50 Lisbon Street - San Rafael
Located in the rear of the building.

SPEED, AGILITY AND QUICKNESS CLINIC

NEXT CLINIC: SUNDAY DECEMBER 1, 2024

JR PERFORMANCE (Ages 8 - 12)
9am - 10am

VARSITY PREP (Ages 13 - 18)
10:30am - 11:30am

*15 Minute Q&A Session Immediately Following

Phone Format: 14156013488

Phone number format: 14156013488

REGISTRATION

*Families with more than one child may sign up each child, however, each child may only sign up for ONE of the clinics. Please register each athlete individually. PARENTS are encouraged to participate in the 15 minute Q&A immediately following the clinic.

Athlete's First Name

Athlete's Last name

Parent's Name (First and Last)

Parent's Email Address

Parent's Phone Number

Parent's Phone Number (Alternate)

Emergency Contact's Name

Emergency Contact's Phone Number

CHOOSE YOUR CLINIC

JR PERFORMANCE CLINIC (Ages 8-13)

VARSITY PREP CLINIC (Ages 13-18)

WAIVER - RELEASE OF LIABILITY - CONSENT

By clicking this box, I certify that I am over 18 years of age and I am the parent or legal guardian of the above athlete and I certify that my child is in sound physical condition to participate in any of the sports performance programs offered by Train2Change Fitness and Performance and the North Bay Basketball Academy. I authorize the staff of Train2Change Fitness and Performance and/or the North Bay Basketball Academy to act accordingly with their best judgment in an emergency situation. I have adequate insurance and hereby release the Train2Change Fitness and Performance directors and staff, the North Bay Basketball Academy and Robert Viramontes from any and all liability in the event of an injury and/or illness requiring treatment, hospitalization, and/or surgery. Train2Change Fitness and Performance, the North Bay Basketball Academy or Robert Viramontes are not responsible for and will not provide any medical, dental, hospital, or laboratory fees due to injury while participating in a sports performance program conducted at the North Bay Basketball Academy. In the event of injury or illness, Train2Change Fitness, their staff and Rob Viramontes have my permission to provide emergency first aid care.

ELECTRONIC SIGNATURE

BY ENTERING YOUR FULL NAME BELOW YOU CERTIFY THAT YOU ARE 18 YEARS OF AGE OR OLDER AND YOU ARE THE PARENT OR LEGAL GUARDIAN OF THE PARTICIPATING ATHLETE.