HoopSource Participant Waiver

PARTICIPANT WAIVER: Hoop Source Grassroots, LLC

(To Be Completed Annually For All Player Event Participants)
Team Name / Team Grade & Gender:*

Team NameTeam Grade & Gender
Player:*

First NameLast Name
Player Jersey #:
Player Birthday:*

MonthDayYear
Date
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name:*

First NameLast Name
Parent/Guardian Email:*
example@example.com
Parent/Guardian Phone:*

Area CodePhone Number
Parent/Legal Guardian's Relationship to Participant:*
Type Response Above
WAIVER FORM & EMERGENCY MEDICAL RELEASE

We authorize all medical, surgical, diagnostic and hospital procedures as may be performed or prescribed by a physician if I cannot be reached in case of an emergency. I hereby grant permission to Hoop Source Grassroots, LLC to have my son/daughter treated by a physician if necessary. Both Participant and Parent/Guardian acknowledge that Participant is physically able according to our physician to participate, and I acknowledge that I am responsible for any and all medical expenses due to my child’s illness or injury.

WAIVER AND RELEASE OF LIABILITY: Participant and Parents or Legal Guardian represent to Hoop Source Grassroots, LLC that Participant is in physically sound condition and has no disability, illness or other condition preventing Participant from participating in sports such as basketball. Participant understands and acknowledges that participation in basketball or other physical activities involves or otherwise includes risk of injury. Participant fully understands, accepts and assumes any and all risks involved or in connection with the participation in these sports and activities. Participant promises and agrees that neither Hoop Source Grassroots, LLC nor any agent, employee, or person associated with Hoop Source Grassroots, LLC or any of its affiliates shall be held liable or responsible for any claims, damages, or losses arising out of or in connection with participant’s use of or presence at Hoop Source Grassroots, LLC premises. Participant further promises and agrees to indemnify and to hold Hoop Source Grassroots, LLC, its agents, employees and its affiliates harmless from any and all claims, damages or losses arising out of or in connection with participant’s use of or presence at Hoop Source Grassroots, LLC premises. Participant further promises and agrees that neither Hoop Source Grassroots, LLC, its agents, employees, or any of its affiliates shall be liable or responsible for any loss or theft of personal property. I understand and acknowledge that signing this release means my name or likeness may be used in promotional materials made available to the public.
Waiver & Release of All Claims:*

I Accept the Above Terms & Conditions
E-Signature: (Participant - Parent/Guardian):*
Should be Empty:

PARTICIPANT WAIVER: Hoop Source Grassroots, LLC