Germantown Heat Basketball Association

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Donations for spring/fall sports

AAU/AYBA Installment or Pre Payment Plan

* First Name:

* Last Name:

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PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

Consent and Liability Waiver - Release of all claims (must be signed to participate)

I, ________________________________ (parent/guardian), am the parent or legal guardian of ________________________ _ (minor child).
As lawful consideration for my minor child being permitted to participate in the Germantown HEAT Basketball Association, Program Camp, Clinic or any other activity at or through the Germantown Heat Basketball Association. I agree that neither my minor child nor I will make a claim against, sue, attach the property of or prosecute Germantown Heat Basketball Association and
Their agents, sponsors, building contractors, suppliers, and employees for damages for death, personal injury or property damage which my minor child may sustain as a result of my child's participation in these sporting activities.
This release is intended to discharge in advance Germantown Heat Basketball Association, and their agents, sponsors, building contractors, suppliers, and employees from and against any and all liability, including for negligent actions, arising out of or connected in any way with my minor child's participation in the sports league, program, camp, clinic or any other activity except for liability that may arise out of the willful or wanton misconduct of Germantown Heat Basketball Association and their agents, sponsors and employees.
I FURTHER UNDERSTAND THAT SPORTS INVOLVE PHYSICAL CONTACT BETWEEN PLAYERS, THAT SERIOUS ACCIDENTS OCCASIONALLY OCCUR DURING SUCH SPORTING ACTIVITIES, AND
THAT PARTICIPANT IN SUCH SPORTING ACTIVITIES OCCASIONALLY SUSTAINS SERIOUS PERSONAL INJURIES (INCLUDING DEATH) AND/OR PROPERTY DAMAGE, AS A CONSEQUENCE THEREOF.
KNOWING THE RISKS OF PARTICIPATION, NEVERTHELESS, I HEREBY AGREE THAT MY MINOR CHILD AND I ASSUME THOSE RISKS AND RELEASE AND HOLD HARMLESS GERMANTOWN HEAT BASKETBALL ASSOCIATION AND THEIR AGENTS, SPONSORS AND EMPLOYEES WHO (THROUGH
NEGLIGENCE OR CARELESSNESS) MIGHT OTHERWISE BE LIABLE TO ME, MY MINOR CHILD (OR OUR HEIRS OR ASSIGNS) FOR DAMAGES.
I attest that I am eighteen (18) years old or older and that my child is physically fit and have no known medical conditions which prohibit participation in this sport. My child and I agree to follow all laws, rules and guidelines regulating the conduct of the league, camp or clinic. I understand and agree that my child and I are responsible for the mechanical and/or operating condition of any and all sporting equipment provided by my child or by me for my child's use, and I agree that my child and I will continuously inspect and maintain all equipment used, even if we have obtained any of the equipment from Germantown HEAT Basketball Association, their agents, sponsors and/or employees.
I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY FOR MYSELF AND MY CHILD AND A CONTRACT BETWEEN MYSELF, MY CHILD AND GERMATOWN HEAT BASKETBALL ASSOCIATION AND THEIR AGENTS, SPONSORS AND EMPLOYEES, AND I HAVE SIGNED IT OF MY OWN FREE WILL.

I also agree that Germantown HEAT Basketball Association and their agents, sponsors and employees may use my child's photograph in future promotions.

I/we agree with the above *

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Donations for spring/fall sports