Point Guard Clinic Registration The cost of this clinic is $95. Player's Name* First Last Grade*School*Town & State of Residence*Parent Cell Phone*Parent Email* Payment InformationClinic Cost Price: $95.00 Method of Payment*I will pay by check or cash at the door.I will pay by credit card.Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Release & WaiverRelease & Waiver Agreement*I hereby agree to indemnify and hold harmless Hoop Dreamz LLC its parent, subsidiary and affiliated entities and/or any officers, partners, members, directors, coaches, employees, servants, agents, licensees and assigns of any of the foregoing, from and against any and all suits, awards, claims, damages, liabilities, costs and expenses (including reasonable attorney fees and related costs) arising out of injury or damages to my child, in connection with his/her participation in any Hoop Dreamz program. I hereby authorize Hoop Dreamz to act for me according to their best judgment in any medical emergency situations. I Agree NameThis field is for validation purposes and should be left unchanged.