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SWAIN BASKETBALL AAU

Player Registration

Parental Waiver/Consent/Liability Release Form

New Player Registration Form

Player Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Player Date of Birth

Age/Grade

Email *

Medical Information (allergies, special medications, instructions, etc.)

Parent/Guardian Name *

First

Last

IN CASE OF AN EMERGENCY, CONTACT/CALL: *

First

Last

Emergency Contact Phone

Medical Insurance Carrier

Physician

Phone

PERMISSION, RELEASE, AND ASSUMPTION OF RISK In consideration of my child being allowed to participate in Swain Basketball AAU activities, I hereby assume all risk and release the Swain Basketball AAU, its employees, and volunteers from all liability whatsoever for any injuries or accidents in connect with my child’s participation. I intend this release to be binding not only for myself, but also for my family and all legal successors in interest. For the safe enjoyment of this program by all participants, Swain Basketball AAU have established rules and regulations and I agree that my child will abide by them, or accept dismissal for refusing to follow them. I hereby grant permission to the Swain Basketball AAU organization to use, for promotional purposes, photographs and video images taken of my child while participating in this program. In the event that my child is injured, and I cannot be contacted, I hereby give permission to the physician or medical personnel selected by the Swain Basketball AAU staff or volunteers to hospitalize, secure proper treatment or medication for, and to take whatever medical actions are necessary to treat my child, and I authorize the physician or medical personnel selected to provide treatment deemed necessary by them. *

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OWN YOUR MOMENT

Player Registration

Parental Waiver/Consent/Liability Release Form

Player Registration

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