Player Application, Medical Release/Waiver, and Media Authorization

Important: Only fill out this application if you have spoken with Coach Barnett (502) 807-7152

  • Player Information

  • Parent or Legal Guardian Information

  • Emergency Contact Information

  • F.O.C.U.S Baskeball Terms and Coditions

    I, being the parent or legal guardian of the child requesting admittance, do hereby affirm that the applicant is in good health and suffers from no illness, disability, or condition that requires the taking of medicine on a regular basis unless the conditions are disclosed and approved. Furthermore, I have no knowledge of any reason the applicant cannot participate in vigorous physical activity.

    I hereby expressly agree to be responsible for any medical bills incurred in the treatment of any injury, illness or accident. In the event of any such injury, illness or accident, I hereby consent to allowing any of the program supervisors to procure any medical treatment deemed advisable on behalf of my child or ward without prior consent. I understand that no primary insurance is provided by F.O.C.U.S. Basketball Academy.

    I understand that as a condition of admittance to the program , I, on behalf of the applicant, hereby release, discharge, and/or otherwise indemnify and hold harmless F.O.C.U.S. Basketball Academy, it's coaching staff, employees, volunteers and other associated personnel, from any and all liability for injuries, illness, mental or physical, suffered by the applicant during or related to the program, unless caused by a willful act of or gross negligence by the person or entity against whom the claim is made.

    I hereby, give F.O.C.U.S. Basketball Academy permission to publish and use pictures and/or videos of which the applicant may be included in whole or in part. Such publication and use of pictures and/or videos may occur on the F.O.C.U.S. Basketball Academy website, brochures, promotional materials or any other documents or social media utilized to further the mission and goal of F.O.C.U.S. Basketball Academy as defined in our mission statement.