Release of Liability
I am the parent/guardian of the student listed above who is participating in the basketball training and academic mentoring program offered by Crossover Mission, Inc., Vero Beach, FL, and held at the Crossover Center, School District of IRC and any other contracted facility, do understand that participation in this sporting activity is potentially dangerous and that physical injury, including serious injury may occur. I give permission for my child/ward to be transported via automobile by a staff member of Crossover Mission, Inc. and hereby waive my rights to all claims for injuries my minor child/ward might sustain while being transported via automobile by a Crossover Mission staff member, tutor, coach or mentor. I agree to accept any liability for personal injury arising out of my child’s participation in athletic, academic and mentoring activities of Crossover Mission.
I understand and acknowledge that Crossover Mission, Inc. is a community supported, 501(c)(3) organization, and I agree it is not a commercial activity.
I hereby release any claim of any nature which I or my minor child might have against Crossover Mission, Inc., its officers, agents and employees and the School District of IRC from any liability for any injury incurred during this program or incurred while being transported by automobile by a Crossover Mission staff member, tutor, coach or mentor. I attest and verify that I have full knowledge of any and all risks involved in such participation, and that I will, on behalf of the named child, assume full responsibility for such risks and pay any and all medical, emergency, and other costs.
I hereby authorize and consent to the use of his/her visual image by Crossover Mission, Inc. for appropriate purposes, including but not limited to: still photography, videotape, electronic and print publications, websites and social media. I give this consent with no claim for payment.
Communication Authorization & Release
I hereby authorize the staff of Crossover Mission, Inc. to communicate with my child for appropriate purposes, using, but not limited to, email, text, cell phone, and other social media.
Tutoring Registration & Release
As parent/guardian, I understand that I will be part of the goal setting process for my child, and I will allow my child’s school to release relevant educational information regarding my child to the tutors/mentors of Crossover Mission, Inc. for academic assistance. I give authorization for my child to be transported by authorized members of the Crossover Mission, Inc. organization for academic support and training purposes.
I allow Crossover Mission access to school academic portals. Included in that is the Indian River County School District FOCUS portal, St. Edward's Student Academic Portal, Florida Virtual Portal, Homeschool Academic Portals and plans, and any other programs aimed at improving academic performance within the school district. These online tools provide updates on my child’s performance and are necessary for effective and meaningful, weekly academic mentoring. In order to provide access to the electronic portals/gradebooks by the Crossover tutors/mentors, I provide Crossover Mission with the separate release forms. All information is kept strictly confidential by Crossover Management.
Emergency Authorization and Health Insurance
I, the undersigned, as parent/guardian of the named child, hereby authorize the staff of Crossover Mission, Inc. and its sponsors and vehicle drivers as my agents, to consent to medical, surgical, dental examination or treatment, and/or care at any hospital or by licensed medical personnel in the event of emergency.
All information is kept strictly confidential by Crossover Management.
Parent Support Requirement
All parent/guardians of Crossover participants are required to volunteer for one event each school year. Please select the volunteer activities that interest you.
I agree to all the terms stated above for my child’s participation in the Crossover Mission, Inc. athletic and academic program. This may also include field trips and out of town events. I attest to the accuracy of the provided information and understand that I must complete this application in its entirety for my child to participate in Crossover Mission.
A fee of $125 per child/per school year is due to participate in Crossover Mission programming.
This fee includes the Crossover Mission basketball uniform.
Throughout the year, there may be additional opportunities for student athletes to participate in the competitive AAU season or for away events or camp experiences. These opportunities are optional and will have additional fees.