Player Profile

LSA Basketball Network Athlete Profile & Wavier Form

Participant Name

Age

Current Grade

Date of Birth

Current School

Parents's Name

Parent Employment

Address

Phone Number

2nd Phone

Email Address (Mom)

Email Address (Dad)

Special Instructions/Health Concerns

Please check one of the below boxes:

I give my permission to LSA to use my athlete’s name and/or photo in any advertisement or publication in relation to LSA. I DO NOT give my permission to LSA to use my athlete’s name and/or photo in above mentioned advertisement or publications.

Disclaimer: Lewis Sports Academy, Coach Lewis, South Cobb HS, Heirway Christian Academy and its individual employees and supporting staff are not and will not be responsible for any injury or death arising from participation in training, programs or activities where the risk of such injury or death has been recognized and acknowledged by the Participant signing this Waiver. Participant releases Lewis Sports Academy, Coach Lewis, South Cobb HS, Heirway Christian Academy and its individual employees and supporting staff from liability for injury or death arising from any such risks.