Court Kings Basketball Academy - (Lompoc, CA)

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CKBA Fall Season 2024

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

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 #:

Waiver of Liability

COURT KINGS BASKETBALL ACADEMY
RISK AND WAIVER OF LIABILITY FORM

As the legal guardian of _________________________________________________, I hereby consent to the aforementioned person participating in the COURT KINGS BASKETBALL ACADEMY programs including but not limited to; tryouts, practices and or games. I recognize that potentially severe injuries can occur in any activity that is associated with basketball and youth sports.

I understand that it is the express intent of the COURT KINGS BASKETBALL ACADEMY, to provide for the safety and protection of my child and, in consideration for allowing my child to play OR TRYOUT for or practice with the COURT KINGS BASKETBALL ACADEMY, I hold the club totally harmless.

I hereby forever release TEAM OVERTIME Basketball Club and its Directors, Coaches, Trainers and staff, AAU Boys & Girls Basketball, or any facility used by TEAM OVERTIME Basketball Club, its officers, employees, coaches and owners from all liability for any and all damages and injuries suffered by my child while under the instruction, supervision, or control of any of the above so mentioned.

As legal guardian of the aforementioned person, I hereby agree to individually provide for the possible future medical expenses which may be incurred by my child as a result of any injury sustained while training at, practicing at, competing at, or trying out for the COURT KINGS BASKETBALL ACADEMY, AAU Boys & Girls Basketball, or any facility used by COURT KINGS BASKETBALL ACADEMY employees, coaches and owners.

In case of emergency, I authorize COURT KINGS BASKETBALL ACADEMY staff to administer first aid to my child and/or take my child to a physician or hospital for further treatment.
This acknowledgment of risk and waiver of liability, having been read thoroughly and understood completely, is signed voluntarily as to its content and intent.

SIGNATURE OF STUDENT:____________________________DATE:_________

SIGNATURE OF PARENT/GUARDIAN:____________________________DATE:_________

PRINT NAME OF STUDENT:_____________________________________________

PRINT NAME OF PARENT/GUARDIAN:________________________________________

I/we agree with the above *

* indicates required fields