Athlete Name *

First Name

Last Name

Parent Name *

First Name

Last Name

Phone *

(###)

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Media Release *

By selecting yes, I give permission for Jon Medina Coaching LLC (JMC) and its representatives to photograph, record, and use images or videos of my child for promotional purposes, including social media, websites, and marketing materials. I understand that these images and videos may be used without compensation.

Yes

No

Liability Release / Assumption of Risk: *

By selecting yes, I acknowledge that participation in basketball training involves physical activity and inherent risks. I understand that Jon Medina Coaching LLC will push athletes responsibly beyond their comfort zones to improve skills and performance. I assume all risks of injury, whether minor or serious, and release Jon Medina Coaching LLC, its coaches, staff, and affiliates from any liability for injuries or accidents that may occur during training, travel, or related activities.

Yes

No