3v3 Basketball Tournament - Athlete Waiver Agreement

ALL PROCEEDS GO TOWARDS Four Diamonds to help PEDIATRIC CANCER Patients and the Kingsmen Club

3v3 basketball tournament. HALF COURT GAME

DATE: 2/24

TIME: report @ 1 pm, 1:00-1:25 check-in/warm up

LOCATION: Wilson High School Upper House Gym

EACH ATHLETE NEEDS TO FILL THIS OUT (INCLUDING TEAM CAPTAIN)

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Email *
What grade are you in? *
What is your team name? 
(If you are unsure please ask your team captain that submitted the registration form) 
*

GENERAL WAIVER & LIABILITY RELEASE  

(Wilson School District -- High School Mini-THON Club)  

I, the undersigned, understand that participation in the Wilson School District’s High School Mini-THON  Club (“Club”) involves physical activity and participation in fundraising events (the “Activities”); that  accidents can occur during the Activities; and that participants in these or any Activities can suffer serious injury  or death. I further understand that the Wilson School District Staff and student facilitators are not medical  professionals and are not trained to diagnose, monitor, or treat chronic or acute medical conditions, whether  preexisting or caused by participation in the Activities.  

Nevertheless, I, ON BEHALF OF THE STUDENT AND FOR MYSELF, HEREBY ASSUME THESE  RISKS OF PARTICIPATING IN THE CLUB AND THE ACTIVITIES.  

In return for allowing the Student to participate in the Activities associated with the Club, I, on behalf of  the Student and for myself, hereby waive, release, and discharge any and all claims for damages for death,  personal injury, disability, or property damage of any kind which may hereafter accrue to the Student or  myself as a result of his/her participation in the Activities and/or Club. This release is expressly intended to  discharge in advance the Wilson School District and its employees, agents, student facilitators, and volunteers  from and against any and all liability arising out of or connected in any way with the Student’s participation in  the Activities and/or Club. THIS WAIVER AND RELEASE SHALL APPLY EVEN THOUGH  LIABILITY MAY ARISE OUT OF NEGLIGENCE OR CARELESSNESS ON THE PART OF  WILSON SCHOOL DISTRICT, INCLUDING ITS EMPLOYEES, AGENTS, STUDENT  FACILITATORS, AND VOLUNTEERS, AND INCLUDING GROSS NEGLIGENCE TO THE  EXTENT THAT SUCH WAIVER AND RELEASE IS PERMITTED BY PENNSYLVANIA LAW. This  Waiver and Liability Release shall apply to the Student and myself, as well as any of our heirs, executors, or  administrators. By my signature below, I hereby certify that I am the parent or legal guardian of the Student  and that I am acting in that capacity. Further, I acknowledge that I have read this document and understand  its contents.  

I, the parent/guardian of the above named the Student, hereby approve his/her participation in the Club and  associated Activities. Further, I consent to emergency medical treatment for the Student should the need arise.  I expect that the activity supervisors will make an effort to contact me, time permitting, before any treatment  other than first aid is administered. 

By typing (signing) my name below I acknowledge that I have read the above information.  *
Parent(s)/Legal Guardian(s)Name(s)and Contact Phone Number:
*
Emergency Contact Name, Relation, and Contact Phone Number:
*
A copy of your responses will be emailed to the address you provided.
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