Bulletin Board
Subscribe to our NewsletterAssumption of Risk
Assumption of the Risk and Waiver of Liability Relating to
Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. West Islip Youth Basketball, Inc. (“the League”) in conjunction with the West Islip Union Free School District (the “District”) and the West Islip Community Center (the “Center”) have put in place preventative measures to reduce the spread of COVID-19; however, the League cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the League could increase your risk and your child(ren)’s risk of contracting COVID-19.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the League and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the League may result from the actions, omissions, or negligence of myself and others, including, but not limited to, League employees, volunteers, and program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the League or participation in League programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the League, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the League, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any League program.
______________________________________________ _____________________________
Signature of Parent/Guardian Date
______________________________________________ ______________________________
Print Name of Parent/Guardian Name of League Participant(s)
Hold Harmless Agreement
Player Name:_______________________________________________ Birthdate:_______________
Address:___________________________________________________________________________
Address:___________________________________ _____________ _____________
(City) (State) (Zip)
Home Phone:________________________ Cell Phone: _________________________
Parent Name(s):_______________________________ _______________________________
(Father) (Mother)
Cell/Emergency Phone:________________________________ _______________________________ (Father) (Mother)
● Health Insurance Provider: _____________________________________ Phone#:___________________
Insurance ID #:________________________________ Group #:________________
Health Conditions/Medications/Allergies: ___________________________________________________
Liability Waiver: Basketball presents certain inherent risks and hazards, which the Player-participant and parent/guardian are urged to consider and which the Player assumes. To the best of my knowledge, there are no physical or other health-related conditions, which will interfere with my child’s participation unless noted above. I, the undersigned parent/guardian for the above named Player, understand and acknowledge that such recreational activities have inherent risks, dangers and hazards, foreseeable and unforeseeable, that may result in injury, illness, or property damage, and on behalf of myself, my family, agents and contractors, I hereby release and agree to hold harmless West Islip Youth Basketball, Inc., it sponsors, volunteer coaches, managers, game personnel, officers and directors from all claims, actions, or losses related thereto. West Islip Youth Basketball, Inc., assumes no liability for injury or damage arising from the results of participation of the above Player unless due to willful fault or gross negligence on the part of West Islip Youth Basketball, Inc. I also agree that my child will be a registered participant under our Excess Medical Liability insurance coverage.
Medical Treatment Release: Due to the strenuous nature of basketball, the Player participant is urged to consult her physician concerning her fitness to participate. I, the undersigned parent/guardian for the above named Player hereby approve of my child’s participation in the West Islip Youth Basketball, Inc. program and consent to emergency medical treatment for my child on my behalf. I also authorize any activity attending adult, volunteer, or organization personnel of West Islip Youth Basketball, Inc. to obtain any necessary medical treatment for my child on my behalf, in case of an emergency, where I am not present and with the understanding that I will be notified as soon as possible. My health insurance information has been provided above.
Parent Signature:______________________________________________ Date:_______________
Print Parent’s Name: ___________________________________________
Coach or Team Manager will have a copy of this form at all practices and games.
Refund Policy (Proposal)
PROPOSAL
West Islip Youth Basketball, Inc. is a charitable, non-profit, 501 ( c )( 3 ) exempt organization; administered by a board and run by volunteers. Our organizational mission is to provide a wonderful basketball related experience. Out Fiscal year begins on September 1st until August 31st of the following year. We incur expenses in preparation for the upcoming season before we begin, during, and after the registration process. The registration fee is reflective of a “Pooled” operating budget approach, aimed to breakeven, financially. Hence, a refund will be emitted in the following manner:
1. 100% if “Refund Request Form” is submitted during Registration Period, usually between November 1st and November 25th of the current Fiscal Year, unless the registration period is extended by The Board.
2. 90% if “Refund Request Form” is submitted before insurances are renewed and in effect for the upcoming Insurance Coverage Period, which normally starts on November 25th of the current Fiscal Year.
3. NO REFUND after uniforms are ordered, around December 5th of the current Fiscal Year.
4. A refund policy exception will be considered by The Board, at their sole discretion upon the determination of the facts, for major injuries occurring during PRE-SEASON or IN-SEASON. The refunded amount will be based on the proportional days of the season to when the injury is formally reported via a Medical Claim and supported by a medical physician’s letter.
If you have a refund request, please fill out the form below, sign and submit the form and documents to: johnyankee23@aol.com or mail it to:
West Islip Youth Basketball, Inc.
102 Raleigh Lane
West Islip, NY 11795
All information is kept confidential within the Executive Board. If you have questions, please contact the Executive Board.
REFUND REQUEST FORM
Parents Name: _________________________________, ______________________________________
Player’s Name: ________________________________
Address: _____________________________________________________________________________
City, State, Zip Code: ________________________________________, __________, _______________
Primary Phone Number: _________________________
Secondary Phone Number: _______________________
Primary Email Address: __________________________________________________________________
Secondary Email Address: ________________________________________________________________
Amount of Registration Fee Requested: $_______________
I hereby apply for a registration fee refund from West Islip Youth Basketball, Inc. for the player listed above, a participant in the current basketball organization season. I understand that any falsified information on this application will render any refund invalid, and the funds will be returned to the West Islip Youth Basketball, Inc.
I further understand that applying for a refund of the registration fee does not automatically result in receiving a refund. The Board must accept, make a decision, and approve the refund.
I certify that the information included in the refund policy form is correct and true to the best of my knowledge.
Parent Signature: ___________________________________ Date: _________________________
Please include:
1. Online Registration Information
a. Entry Date
b. Entry ID
2. Bank Information (If applicable)
a. Bank Name
b. Routing Number
c. Account Number
d. Account Type
i. Checking
ii. Savings
Operating expense considerations:
1. Insurance
2. Website
3. Advertising and Promotion
4. Meals
5. Rental Agreements
6. Permits
7. Professional Fees
8. Contributions and Donations
9. Uniforms
10. Supplies
11. Officiating
12. Travel
