COVID-19 Liability Waiver

1
Date* This field is required.
Date
Month
Day
Year
2
Name* This field is required.Please make sure you fill out a wavier for all participants entering gym(s)
First Name
Last Name
3
Who is This Waiver For?* This field is required.Please make sure each Coach, Player, Parent and Spectators complete a separate waiver.
Coach
Player
Parent
Spectator
4
GRADE/DIVISION* This field is required.Please select below
1ST
2ND
3RD
4TH
5TH
6TH
7TH
8TH
9TH
JV
VARSITY
5
Team Name* This field is required.List all team(s) your son/daughter are playing on; example: Chaos 5 Boys, Hornets 8 Girls, etc.
6
Type a question* This field is required.Who Is The Waiver For?
Male
Female
N/A
7
Email* This field is required.
example@example.com
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I acknowledge that this waiver allows the registered to participate in programs offered by Junior Athletics of the Midwest, Inc. (JAM Basketball) and is a defining condition of participation. I certify that the participant is in excellent physical health and has no physical limitations except as mentioned in the Medical Release information provided during the registration process. I recognize that youth sports consist of activities that are considered strenuous and hazardous physical activities, and I hereby release and discharge JAM Basketball and all their affiliated entities from any and all liabilities, losses, claims [including negligence] and demands for personal injury, property damage, and/or any other loss(es) suffered by me or my child in connection with his/her participation in JAM. I represent that I am legally authorized to enter into this agreement both for myself and all parents and guardians of the registered minor. I agree that the grant and release contained herein binds me and the registered to all its terms. By signing this agreement, I also 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 participating in this program and that such exposure or infection may result in personal injury, illness, permanent disability, or death. I understand that the risk of becoming exposed to or infected by COVID-19 while participating may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Junior Athletics of the Midwest, Inc. (JAM Basketball) employees, volunteers, and program participants and their families. Image Use Release: I hereby give Junior Athletics of the Midwest, Inc. (JAM Basketball) the irrevocable right and permission to copyright and publish any photographs, audio tapes, and/or video tapes taken of me or my child/player for use in any of its printed publications, audiovisual presentations, website, social media sites and/or online presentations, related to its education mission. I also waive the right to approve the final product. I hereby warrant that I am of full age and competent to contract in my own name and that I am signing this release not only for myself but for my child/player. I represent that I have the authority to sign this release on behalf of myself and my child/player.
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Terms and Conditions* This field is required.
10
Signature* This field is required.
Clear
11
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