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                                    Jam On It Basketball Academy 
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                   Boy       or      Girl
Student's Name     
Parent's  Name     
Mailing Address  City, State, Zip
Players Email Address Parents Email
Home Phone Work Phone 
Cell phone  Emergency contact and number
School
AGE     Birth Date  Grade

   Do you have a Jam On It Uniform      Yes   # ____        No
All Players must purchase an AAU card ($14)
All Players must be register with AAU 
New Student Essay

 What is your parents occupation?
 Mom Dad 

Attach a 50 word essay on why you should be selected for Jam On It
We need a copy of your Birth Certificate, Report Card and School Picture.

WAIVER

We acknowledge that participation in the Academy may result in serious injury and do hereby waive, release, absolve, indemnify and agree to hold harmless the Jam On It Basketball Academy, it’s staff, coaches, organizers, sponsors, supervisors, participants and persons transporting our son/daughter to and from activities for any claim arising out of any injury, except to the amount covered by accident or liability insurance.
In the event of illness, accident or injury, we hereby authorize and give full permission for our son/daughter to be transported to an area hospital, and to be given medical care by emergency room physicians or any other physician that is necessary for the health of our child. We understand that we are responsible for all medical costs.

Parent's Signature Date

Make Checks payable to Jam On It Basketball Academy:
PO Box  52049 Sparks NV 89435
.