I hereby give my consent for the above-named student to participate in the Pee Wee basketball hosted by Legacy Academy in Lockesburg. I realize that there is a degree of danger involved in almost any activity associated with sports, recreation, or physical activities and will not hold Legacy Academy or the PeeWee program responsible for injury or harm to my child. If emergency medical action or treatment is required and neither parent nor guardian can be contacted, I hereby give my consent for the student named above to be administered medical care by the physician or licensed hospital deemed most expedient by the coach or program representative in charge for the good of my child. The local fire department or paramedic unit may be used or students may be transported to the nearest emergency facility. I understand that I am fully responsible for any expenses associated with or resulting from medical care administered to the above-named student (which might also include ambulance service) and agree to assume the financial responsibility for such services. I also understand that my child may be photographed, videotaped, or audiotaped by a program representative, parent volunteers, or public media personnel. I give my permission to release any photographs, video images, or audiotapes of my child taken during the PeeWee Program, for use in publications, website, social media, as well as public media use. In signing this application, we as parents/guardians realize we are entering into a contract with Legacy Academy (LA) and the PeeWee Program agreeing to familiarize ourselves with, abide by, and support the policies and rules established for the program. I acknowledge that my child may not be left unsupervised at the gym. We agree to follow the rules and be responsible for all incurred fees. This consent and authorization is to continue for the entire PeeWee program. *
