Admissions – PacWest Post Grad Conference

Player Name:

First

Middle

Last

Twitter:

Example: @PacWestPGC

Phone:

Email:

Date of Birth:

Current Age:

Gradution Class

Please provide your current year of graduation?

GPA:

Please provide your current High School Grad Point Average?

Test Scores: (ACT /SAT)

School Name

Please provide the name of your graudating school or the last High School you attended.

Did you Graduate?

Yes (If "YES" please upload a copy)
No

Graduation credentials received?

HS Diploma
GED
Certificate of Completion

File Upload

Click or drag a file to this area to upload.

Please upload a Photocopy of your High School Diploma or GED Certificate:

Sport:

Height:

Weight:

Football Position:

Basketball Position:

Baseball Position:

Game Film or Highlight:

Example: Hudl, Quick Cuts, Youtube (Paste Link)

Shirt Size:

Short Size:

Parent/Guardian Name

First

Last

Parent/Guardian Phone:

Parent/Guardian Email

File Please

Do you have any known medical conditions?

Yes (If yes, please specify)
No

If yes, please specify:

Are you currently on any medications?

Yes (If yes, please specify)
No

If yes, please specify:

Do you have any allergies?

Yes (If yes, please specify)
No

If yes, please specify:

Permission & Agreement

I agree and give my permission

Consent and Agreement Form:

Acknowledgment of Risks By signing below, I acknowledge that participation in the PacWest Post Grad Conference involves athletic activities and other related events that carry inherent risks, including but not limited to physical injury, death, or other consequences. I am fully aware of these special dangers and risks and accept responsibility for them.

Certification of Information I certify that all the information I have provided is accurate to the best of my knowledge. I further agree to inform academy officials, activity planners, coaches, and staff members of any physical or mental limitations that may affect my participation.

Assumption of Responsibility I accept full responsibility for my personal property and equipment used in connection with this activity. I understand that PacWest Post Grad Conference, its insurance, or the facility hosting this event will not cover any risks or injuries associated with my participation.

Liability Waiver and Indemnification In consideration of my participation, I hereby release, indemnify, and hold harmless the PacWest Post Grad Conference, its staff, officials, and agents from any liability, claims, or causes of action arising out of or connected with my participation in this activity. This release extends to all risks, whether foreseen or unforeseen.

Photo and Likeness Authorization I authorize the PacWest Post Grad Conference official to use my or my child’s photo or likeness at their discretion for promotional purposes without additional compensation.

Medical Consent I authorize any medical personnel to treat any illness, injury, or other medical condition that may arise during my participation. I accept full financial responsibility for any medical costs incurred as a result of such treatment. Binding Agreement I have read and understand this release and indemnification agreement.

By signing, I acknowledge its binding nature upon myself, my heirs, representatives, successors, assigns, and administrators.

Please confirm your Consent and Agreement Form acknowledgment: