DOC’S  CALTECH  BASKETBALL  ACADEMY  2016 YOUTH:  FOR  ENTERING  FIRST  -­‐  EIGHTH  GRADERS  /  ELITE:  FOR  HIGH  SCHOOLERS

DIRECTED  BY  CALTECH  MEN’S  BASKETBALL  HEAD  COACH  DOC  ESLINGER  AND  HIS  STAFF  

WWW.DOCSBBALLACADEMY.COM

REGISTER NOW for 2 YOUTH WEEKS! June 13-17 & June 20-24 ELITE Session: June 24-26

Learn  from  the  smartest   team  in  the  world! Doc’s Basketball Academy provides essential instruction to enhance performance in basketball. Caltech Men’s Basketball Head Coach Oliver “Doc” Eslinger Basketball Office: 626-395-3264 Main Desk: 626-395-3253 Email: [email protected]

1st-4th graders: 9 AM-12 PM 5th-8th graders: 1 PM-4 PM ask about full day option... REGISTER and PRINT FORMS ONLINE: www.docsbballacademy.com

Caltech Basketball Mailing Address: 1200 E. California Blvd., MC 1-2 Pasadena, CA 91125

Players will receive: • Training by college staff & players • Versatile skill instruction • In-game coaching strategies • Mental game lessons and tips • Collegiate-like drills • Film breakdown sessions • Special guest lectures • College player demonstrations • Academy competitions • Daily and weekly awards • Individual week-end evaluations

Youth  Academy:  June  13  -­‐  17  &  June  20  -­‐  24

Elite  Academy  is  6-­‐9  pm  June  24,  9  am-­‐4  pm  June  25,  9-­‐11  am  June  26  

Signing  up  is  easy!   1. Fill  out  this  enrollment  form  and  the  attached  waiver  for  each  child/ participant 2. Mail  both  with  a  check  or  bring  both  with  cash  to  Doc  at  the  address   below

Participant Info: First Name: Last Name: Grade Fall 2016: Home Address:

Home Phone:

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Cell Phone:

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Email: Birthday: Month/Day/Year

T-shirt size: “Our college program is built on sound fundamentals. We’ve set more than 80 program records by teaching the game. It is our mission to show each student athlete all the skills necessary to become a complete basketball player. We strive to develop versatility in each player so he can make every part of his game a strength.” - Doc Eslinger

youth / adult S M L XL (circle)

Choose your Sessions (check all that apply): ____ June 13-17 AM SESSION ____ June 13-17 PM SESSION ____ June 20-24 AM SESSION ____ June 20-24 PM SESSION ____ Both AM ____ Both PM ____ All Day _____ ELITE

Payment enclosed: $______ pay to Caltech Men’s Basketball Early Bird! SIGN UP BY MAY 1 & GET A $25 DISCOUNT! *not applicable for Elite

___ $175/session for first YOUTH participant ____ $120/for ELITE ___ $125/additional YOUTH session or for sibling (name) ________ ___ $150/person for group of 3 or more (LIST names of all in group) ________________________________ ____ $350/session all day ___ (circle) early arrival / late pickup: add $25 per person/session

Caltech Basketball Mailing Address: Coach Eslinger 1200 E. California Blvd. Braun Athletic Center, MC 1-2 Pasadena, CA 91125

My child is covered by: Insurance Co:

Policy No:

Allergies/Med. needs Doctor’s name: Doctor’s telephone:

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Doc’s Basketball Academy at Caltech



Summer 2016

CONSENT, RELEASE AND ASSUMPTION OF RISK FOR PARTICIPATION IN DOC’S CALTECH BASKETBALL ACADEMY AT THE CALIFORNIA INSTITUTE OF TECHNOLOGY [For participants under 18 years of age] Dates of Academy: from ________________ to ________________ 1.

I, ___________________________, am the parent or legal guardian of (Child’s Name) ____________________________, a minor.

2. I give my permission for my child to participate in Doc’s Basketball Academy at the California Institute of Technology Athletic Facilities, beginning on [June 13 / June 20 / June 24] through and including [June 17 / June 24 / June 26]. 3. The activities of the Event involve coming to the campus of Caltech to participate in all basketball related activities, including drills, games, and strategy sessions. 4. I understand that my child’s participation in the Event is completely voluntary. I further understand that there are inherent risks of injury, serious bodily harm, or death associated with the Event. In particular, the risks of the Event include, but are not limited to, personal physical injury, equipment malfunction and/or failure, damage to property, actions of other people, and other injuries arising out of or connected with my child’s participation in the Event. I expressly agree to accept and assume all such risks, including personal injury and death, arising in any way from my child’s participation in the Event. 5. I represent that my child has no physical or mental condition that prevents him/her from participating in the Event in a manner that is safe for others, and acknowledge that it is my responsibility to take all appropriate actions in advance of my child’s participation in the Event. I further acknowledge and agree that I have the responsibility to consult with my child’s physician to determine if medical conditions exist that would pose a direct threat to my child’s health or safety or the health or safety of others. READ THE FOLLOWING PARAGRAPHS CAREFULLY - BY SIGNING YOU WILL BE WAIVING LEGAL RIGHTS 6. In consideration my child of being allowed to participate in the Event, I expressly agree to accept and assume all such risks including personal injury and death, arising in any way out of my child’s participation in the Event. I elect to allow my child to participate in the Event despite the inherent risks. 7. In consideration of the benefit my child will receive from participating in the Event, I hereby agree, on behalf of myself and on behalf of my assignees, descendants, dependents, heirs, next of kin, distributees, parents, guardians, executors, administrators, successors, estate, and legal or personal representatives, to release and discharge and promise not to sue Caltech and any subsidiary or affiliate or government sponsor of Caltech (collectively referred to as “Caltech”), as well as any person acting in his/her capacity as employee, officer, trustee, agent, contractor, or representative of Caltech (collectively referred to as “Released Parties”), from and with respect to any and all claims, demands, actions, suits, causes of action, and liabilities of whatever kind or nature in law, equity or otherwise, that may arise from, are related to, or are in any way connected with the Event, including injury, death, damage or loss, whether it results from the negligence of Caltech and/or any other Released Parties, or from any other cause, provided, however, that this does not extend to gross negligence, willful misconduct or a violation of law by Caltech or any other Released Parties. I knowingly and voluntarily waive any and all rights and benefits conferred upon me by the provisions of Section 1542 of the California Civil Code or by any similar law or provision, which Section reads as follows: “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM OR HER MUST HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR.” 8. I agree to indemnify and hold harmless Caltech, its trustees, officers, employees, insurers and agents from all loss, expense (including attorneys’ fees), fines, proceedings, suits, claims, damages, actions, judgments of any nature whatsoever arising out of or in any way connected with the Event. I understand and agree that if a claim, suit, or attachment is brought or sought against me as a result in any way of my child’s participation in the Event, I shall not be entitled to any defense or indemnification by Caltech in connection with such claim, suit, or attachment. 9.

I hereby grant to Caltech the right to make, use, create derivative works, or display: (1) photos, video or audio tape recordings of my Child (“Images”) or

(2) artwork (in any media, including drawings, photos, music and video creations) created by my Child and submitted to Caltech in any manner or form, and for any lawful purpose at any time. I also grant Caltech the right to use my Child’s name associated with such Images of my Child or with his/her artwork. I understand that my Child may be photographed or video or audio taped verbatim and that Caltech may allow persons external to Caltech to view the pictures or recordings in part or in their entirety. I also understand that any artwork submitted by my Child to Caltech as part of his or her participation in the Event may be edited, reproduced or displayed publicly at Caltech’s discretion. I am fully aware and agree that such use of my Child’s image or artwork and name may include posting on publicly available internet sites, including Caltech sites and other publicly viewable social media sites. I waive any right that I may have to review or approve of any finished products, or the uses to which such products may be applied. I release and discharge Caltech, its employees, sponsors, and subcontractors from any liability to me by virtue of any representation that may occur in the creation, editing or use of said Images or the editing or use of my Child’s artwork.

10.

In case of an emergency and if I cannot be reached I, the undersigned parent or guardian of the above named child, do hereby consent to any x-ray, anesthetic, medical, or surgical diagnosis or treatment and hospital care deemed advisable and rendered by any licensed physician or surgeon. This authorization is given in advance of any required care to empower a representative or other official of Caltech to give consent for such treatment as the physician may deem advisable. This authorization is effective unless revoked in writing. I accept full responsibility for any medical expenses incurred as a result of these actions.

_______________________________________________________________________ (Parent/Guardian Name) _______________________________________________________________________ (Address)

(City, State, Zip)

_____________________________

___________________________________

(Home Phone)

(Work Phone)

In case of emergency, if I cannot be reached, please notify: ____________________________________ _________________ (Name)

(Home Phone)

______________ (Work Phone)

________________________________________________________________________ Medical Insurance Carrier ________________________

Policy Number ________________________

Family Physician or Practioner: _________________________________ Address: __________________________________________________ Street __________________________________________________ City

State

Zip Code

Telephone (___)______________________________________________

11. 12.

This Agreement shall be governed by, construed and interpreted in accordance with the laws of the State of California. I represent and warrant that I have the full right, power and authority to enter into and execute this Consent, Release and Assumption of Risk (this “Release”) and to grant all rights granted under it.

I HAVE CAREFULLY READ THIS CONSENT, RELEASE AND ASSUMPTION OF RISK AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY, AN ASSUMPTION OF RISK, AND A PROMISE NOT TO SUE OR MAKE CLAIM, AND I SIGN THIS OF MY OWN FREE WILL. I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CA THAT THE FOREGOING IS TRUE AND CORRECT.

Executed this _____ day of ________________ 2016 at _________________________County, California. Signature of Parent or Legal Guardian: ____________________________________ Print Name: ____________________________________ YOUR CHILD WILL NOT BE ABLE TO PARTICIPATE IN THE EVENT AND USE CALTECH ATHLETIC FACILITIES UNTIL THIS SIGNED FORM HAS BEEN RECEIVED BY CALTECH.