www.triplethreatct.com
Introduction Class K-2 -
6 Week Session Session
4:00PM – 5:00PM
New Player
Returning Player
K – 2 - $75
3-8 - $90 (6 Week Session)
K-2 - $410
3-8 - $500 (Yearly Registration)
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Division 1 – 2 Grade – 5 Grade
Total $_____________________+$25 (For New Player) __________
5:00PM – 6:30PM
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Please make checks payable to Triple Threat Basketball
Send Complete Application with Payment to:
Triple Threat Basketball Training Academy, LLC
150 South King Street
Danbury CT, 06811
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Division 2 – 6 Grade – 8 Grade
6:30PM – 8:00PM
In the event that a check is returned for insufficient funds, the check writer will be required to pay a $20 service fee, any back charges
incurred by Triple Threat Basketball Training Academy, LLC as a result of the returned check and the face value of the check
NO REFUNDS
_______________________________________________________________________YS___YM___YL___AS___AM___AL___AXL___
Players Name
Shirt Size
_______________________
Current Grade
Street Address
_________________________________
School
City
___/___/_____
Date of Birth
State
Male
Female
Zip
___________________________________________________
Parent’s Name(s)
______________________
Phone 1
__________________________
Phone 2
___________________________________________________
Primary E-Mail
____________________________________________________
Secondary E-Mail
______________________________________________
Emergency Contact – other than parent
________________________________________________
Emergency Phone Number
___________________________________________________ ______________________________________________
Primary Insurance Company & Insurance ID
Any known player medical issues or allergies
________________________________ _________________________________ ________________________________
Player’s Physician & Physician Phone #
Player’s Dentist & Dentist Phone #
How did you hear about Triple Threat?
In enrolling at Triple Threat Basketball Training Academy, LLC, participant understands that he/she attending the program and using Triple Threat Basketball Training Academy, LLC and the
facilities does so at his/her own risk. Triple Threat Basketball Training Academy, LLC and its owners, employees or agents, shall not be liable for any damage whatsoever arising from any
personal injury or property loss sustained by participant with his/her family in or about any programs on the premises. Participants and parents assume full responsibility for all injuries and
damages which occur in or about any programs on the premises. He/She does herby fully and forever release discharged hold harmless Triple Threat Basketball Training Academy, LLC, all
associated facilities and its owners, employees, and agents from any and all claims, demands, damages or rights of action, present or future resulting from any person’s participation in any
programs or use of the facility. In addition, he/she agree(s) to follow the rules of conduct and play set by Triple Threat Basketball Training Academy, LLC. Failure to do so may result in
suspension from participation.
Consent: I the undersigned parent or guardians do hereby grant authority to the staff at Triple Threat Basketball Training Academy, LLC to render a judgment concerning medical assistance or
hospital care in the event of an accident or illness during my absence.. I do hereby authorize Triple Threat Basketball Training Academy, LLC and it assigns to utilize any and all photographs,
pictures or other likeness of me or anyone assigned guardianship to me, as they deem appropriate in it promotional materials or team films.
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Parents Signature
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Date