Michael’s 2024-2025
Basketball Program
Cell phone and Wechat: 647-339-6038
Email: Torontobasketballcoach@[Link]
This application may only be completed by a parent or legal guardian of a minor having legal authority
to enter into an agreement on behalf of the minor (“parent/guardian”).
If you have questions, please contact us at 647-339-6038 or email me at
Torontobasketballcoach@[Link]
Student Information
William
First Name____________________________ Wang
Last Name____________________________________
2016/10/29
Birthdate ______________________________ Richland Academy
School Attending_______________________________
PARENT/GUARDIAN INFORMATION
Only a custodial parent or legal guardian for this participant should be listed below, as this person will be the only one able to access
and change this participant’s information before and/or during Camp. (For example: changing the persons authorized to pick up this
participant).
Jenny
First Name________________________________ Wang
Last Name____________________________________
4168189886
Phone #______________________________________ jenny4134@[Link]
Email _____________________________________________
Address______________________________________
EMERGENCY CONTACT
Please provide an emergency contact for us to reach out to in the event we cannot reach the parent/guardian listed above.
Jenny
First Name________________________________ Last Name____________________________________
4168189886
Tel_______________________________________ Mom
Relationship___________________________________
BASKETBALL PARTICIPATION WAIVER AND MEDICAL CONSENT STATEMENTS
Please read carefully:
1. I understand as a parent/guardian of a child who is a participant in the Jr. NBA Basketball
Program, my child will participate in activities including but not limited to physical activities,
group games and learning activities.
2. I agree that the choice to participate brings with it the assumption of those risks and results that
are part of these activities resulting from any cause whatsoever including, but not limited to:
missed doses of medication; contracting COVID-19; scrapes, bruises, fractures and other injuries
sustained in physical activity.
(Continue on next page)
3. I agree that Fit Kids For Life employees, agents and independent contractors, shall not be liable
for any personal injury to my child or any loss/damage to my child’s personal property arising
from, or in any way resulting from, my child’s participation in these activities due to any cause
whatsoever, including negligence, breach of contract, or breach of any statutory duty of care or
other duty of care, including any duty of care owed under any applicable occupier’s liability
legislation.
4. I authorize Fit Kids For Life staff to administer first aid to my child and to secure medical care for
my child in an emergency as deemed appropriate by the attending physician(s).
5. I certify that the information provided in this registration form is, to my knowledge, true and
complete.
6. I have read and understood the above waiver and consent and confirm that I am the parent or
legal guardian of the child mentioned herein who is a minor.
7. I confirm that I have the complete custody, care and control of the minor and have the legal
authority.
☐ I have read and agree to these terms.
ACKNOWLEDGMENT
1. Review of Basketball Participation Waiver: I have had full opportunity to review the Waiver and fully
understand the terms of the Waiver and the fact that I am waiving certain legal rights which my child or
their heirs, next of kin, executors, administrators, assigns and representatives may have against Fit Kids
For Life and it’s staff.
2. Opportunity to Obtain Independent Legal Advice: I have had full opportunity to obtain independent
legal advice relating to the Waiver.
3. No Pressure or Influence: I am granting this Waiver freely and voluntarily and as my own act without
any pressure or influence from or by any person.
4. Reliance: Fit Kids For Life is relying on this Acknowledgment and Waiver in entering into this
Agreement.
Jenny
Name of parent/legal guardian________________________________ 2025/05/07
Date__________________
JW
Signature of parent/legal guardian______________________________________________________
Health Form
William
First Name____________________________ Wang
Last Name__________________________
2025/10/29
Birthdate ______________________________
2762469852PF
Student’s Health Card #: ____________________________ 2025/10/29
Expiry Date: ____________________
Out-of-Canada campers: indicate any medical plan, numbers & billing address, (attach separate piece of
paper if necessary)
ALLERGY INFORMATION
Does your child have any life-threatening allergies or medical conditions? If yes, please list the allergy,
triggers and symptoms/warning signs below.
1. Allergen (substance or condition that causes an allergic reaction):___________________________
• Is this an anaphylactic allergy? Yes ☐ No ☐
• Is an EPI Pen provided for this allergy? Yes ☐ No ☐
• Symptoms and warning signs:
______________________________________________________________________________
______________________________________________________________________________
• The onset of the allergic reaction is brought on by: (check all that apply)
☐ Ingestion ☐Touching it ☐ Smelling it Other___________________________
Allergies
Allergic to: Medication prescribed
Special Instructions and Warning Signs:
Is there anything else that we need to know to provide proper care for your child? Be sure to fully
explain any conditions your child is currently experiencing. It is important to include ALL information
regarding your child's history of illness so that our staff are prepared in case of incident or emergency.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
JW 2025/05/07
Signed_______________________________ (parent or guardian) Date__________________
