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Internation Spring Tryouts/Evaluations Registration Form K-8th

PLAYER INFORMATION

PARENT/GUARDIAN #1

PARENT/GUARDIAN #2

MEDICAL/EMERGENCY CONTACT INFORMATION

WAIVER INFORMATION

WAIVER, INDEMNIFICATION, RELEASE OF LIABILITY AGREEMENT AUTHORIZATION, PERMISSION TO USE NAME AND LIKENESS FOR PUBLICITY AND DISPLAY OF IMAGES ON THE INTERNATION BASKETBALL WEBSITE AND OTHER MEDIA.(COVID-19)

PLEASE READ CAREFULLY – THIS AGREEMENT AFFECTS IMPORTANT LEGAL RIGHT
This Waiver, Indemnification, Release of Liability Agreement Authorization, Permission to Use Name and Likeness for Publicity and the Coronavirus infection ( Covid 19 ) will be effective until termination as described in paragraph #8.
In consideration of being permitted to participate in any way, including travel to and from related events and activities of Internation Basketball , I, for myself, my personal representatives, heirs, executors, next of kin, and assigns, do hereby:
1) Acknowledge that I am familiar with the sport of Basketball and understand the
rules governing the sport of Basketball and the importance of following these rules. 2) Acknowledge and fully understand that I will be engaging in a contact sport that
might result in serious injury, including permanent disability or death, and severe social and economic losses due to, not only my own actions, inaction or negligence, but also to the action, inaction or negligence of others; the rules of the sport of Basketball; or conditions of the premises or any equipment used.
3)I agree, represent, and warrant that neither I or my children shall participate if experience symptoms of COVID-19, including, without limitation, fever, cough or shortness of breath or had been suspected or diagnosed/confirmed case of COVID-19 . I agree to notify Internation Basketball immediately if I believe that any of the foregoing restrictions may apply. Further, I acknowledge that there may be other risks not known to me or not responsibly foreseeable at this time. 4) Knowing the risks involved in the sport of Basketball, I assume the risks and
accept personal responsibility for the damages following such injury, permanent disability, or death. 4) Acknowledge that this waiver, indemnification and release of liability expressly
include transportation to and from, or in connection with any activity or event of the Internation Basketball , in any vehicle, including transportation to and from medical treatment. Understand and agree that by signing this waiver, indemnification and release of liability, I am agreeing to release, indemnify and hold them harmless from and all liability, or costs, including but not limited to attorney fees, associated with or arising from my participation. 5) Understand and agree that if I am signing this waiver, indemnification and
release of liability on behalf of and conjunction with my minor child that I will be giving up the same rights for said minor as I would be giving up if I signed this document for my own participation on my own behalf. I further agree that as a parent(s) or legal guardian(s) of a minor participant under 18 years of age, that I will instruct the minor participant to the above warnings and conditions and their ramifications, and that I consent to the minor’s participation. 6) Understand and agree that this agreement shall be governed by and construed in
accordance with the Laws of the State of California. All disputes and matters whatsoever arising under, in connection with, or incident to this agreement shall be litigated, if at all, in and before a court located in the State of California, U.S.A. to the exclusion of any other State or Country. 7) Understand and agree that this agreement may be terminated only by:
a. Ceasing to participate in any and all activities of the Internation
Basketball Organization b. Providing written notice to the Team Cal Youth Basketball Organization; OR c. Signing and returning to Internation Basketball a later version of the waiver, indemnification and release of liability agreement.
Termination by written notice to the Internation Basketball will not be effective until 30 days after I cease being a member of Internation Basketball or immediately if advised by the President or Board of Directors.
I have read the above waiver, indemnification, and release of liability agreement, and understand that I give up substantial rights by signing it and knowing this, sign it voluntarily, I further agree that no oral representations, statements, or inducements, apart from the above agreement have been made. I acknowledge that this agreement is intended to be a broad and inclusive as is permitted by law and if any portion is held invalid, it is agreed that the balance shall, notwithstanding, continue to have full force and effect. I agree to participate knowing the risks and conditions involved and do so entirely upon my own free will. My signature below shall be a declaration that I have so read and understand this Waiver, Indemnification, and Release of Liability Agreement
A photocopy of this Waiver will have the same effect as the original.

Authorization and Consent for Medical Treatment
I/we the undersigned parent, parents or legal guardian of the above named minor, do herby authorize in the event of an injury, accident, or illness, the Internation Basketball , it coaches, team representatives, directors, officers, agents and assignees to seek and obtain care and medical treatment as shall be necessary under the circumstances. I/we hereby authorize and direct the above named to consent to any x-ray examination, Anesthetic, medical or surgical diagnosis, or treatment and hospital care which is deemed advisable and rendered under the general or special supervision of any member of the Medical staff and emergency room staff licensed under the provisions of the Medical Practice Act, of a dentist licensed under the provisions of the Dental Practice Act, and on the staff of any general hospital holding a current license to operate a hospital from the State Department of Public Health or its equivalent. This authorization is effective whether such diagnosis or treatment is rendered at the office of said physician or dentist, at a hospital, or elsewhere. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of my aforementioned agents to five specific consent to any and all such diagnosis which in the exercise of his or her best judgment may deem advisable. It is understood that effort shall be made to contact the undersigned before rendering treatment to the patient, buy that any of the above treatment will not be withheld if the undersigned cannot be reached. I also agree that this authorization to treat shall be valid in any state where such treatment is rendered.
 

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