Rockland Woodz Basketball Club

Registration Form 2019-20 – Family 3 or More Players

1st Player Information

2nd Player Information

3rd Player Information

Family Information


WAIVER OF LIABILITY, CONSENT FOR MEDICAL TREATMENT, & CONSENT FOR NAME USE

I, the undersigned parent or legal guardian of the above named player, “Registrant” recognizes that basketball can be a dangerous activity, yet I wish to assume all risks associated with participation in basketball activities to be conducted during Rockland Woodz Basketball Club’s games, practices, and/or all other activities. Activities include but are not limited to: playing basketball or attending a game, tournament play, practice, or scrimmage. With full knowledge of the above-referenced risks, I hereby accept and assume full responsibility for any and all harm caused by negligence and release, discharge and/or otherwise indemnify Rockland Woodz Basketball Club, their coaches and staff, directors and officers, league and tournament sponsors and their directors and officers and any of their facilities utilized for basketball activities as to any claims and causes of action by or on behalf of the Registrant and her parents or legal guardians. My child, the “Registrant” and I hereby acknowledge that Rockland Woodz Basketball Club is in no way an extension or affiliation of Rockland Woodz Elementary School and/or Washington County Public Schools and thereby hold harmless and indemnify the above-listed entities for any injury or damage incurred while participating in Rockland Woodz Basketball Club practices, games, tournaments, and/or all other activities.

With full knowledge of the risks of injury in the game of basketball, I hereby authorize the following persons to administer emergency medical treatment to my child, the Registrant, for any injury and/or other medical emergency while at a practice, game, tournament, or scrimmage: all coaches of my child’s team, all officers and officials of the basketball club to which my child’s team belongs. This consent also extends the right to those persons listed above to arrange for immediate medical treatment by a licensed physician and/or other trained medical personnel, and for them to provide such emergency medical care, as they deem appropriate to preserve the life or well-being of my child. My child, the “Registrant” and I hereby release, hold harmless and indemnify the above-listed persons for any injury or damage related to administration of emergency medical care as authorized herein.

I acknowledge that before signing, I had an opportunity to contact Rockland Woodz Basketball Club to discuss any questions I had about the above release and consents. This shall remain in effect throughout the child’s participation in this program for the 2019-2020 season.
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