Name *

First Name

Last Name

Emergency contact

Name, phone number

(###)

###

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I understand that participation in Xplosive Athletics homeschool basketball activities involves the risk of injury. By selecting the below box and submitting this form, I the parent/guardian acknowledge all risk and affirm I am willing to assume all responsibility should injury result from them. Xplosive Athletics will not be held liable for any injuries that may occur at location or during programs or activities. *

Yes, I agree

No, I choose to no longer participate