Player Liability Waiver

Player Liability Waiver

Willie Diggs Basketball Academy
Player Name*

First NameLast Name
Grade*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Parent/Guardian Information #1*

First NameLast Name
Phone Number #1*
Please enter a valid phone number.
Parent/Guardian Information #2

First NameLast Name
Phone Number #2
Please enter a valid phone number.
Email*
example@example.com
Local Emergency Contact:

First NameLast Name
Contact Phone Number
Please enter a valid phone number.
Medical Restrictions: (if none, please state "None")*
PARENT AUTHORIZATION, RELEASE AND INDEMNITY (must be signed and dated below)

BY MY ACCEPTANCE, I HAVE VOLUNTARILY SIGNED UP TO PARTICIPATE IN WILLIE DIGGS BASKETBALL ACADEMY ACTIVITIES AND I DO HEREBY ASSUME ALL RISKS OF PERSONAL INJURY OR ILLNESS INVOLVED IN THESE ACTIVITIVIES AND AM AWARE OF THE SERIOUS ACCIDENTS THAT MAY OCCUR. ACTING FOR MYSELF AND MY CHILD, I DO HEREBY RELEASE WILLIE DIGGS BASKETBALL ACADEMY AND ITS COACHES, REPRESENTATIVES, AGENTS, AND ANYONE ACTING ON ITS BEHALF OF ALL LIABILITY, INCLUDING CLAIMS AND SUITS AT LAW OR IN EQUITY, FOR ANY INJURY, ILLNESS, DAMAGE OR DEATH WHICH MAY RESULT DIRECTLY OR INDIRECTLY BY REASON OF OR IN CONNECTION WITH MY CHILD’S PARTICIPATION OR MY PARTICIPATION IN THIS ACTIVITY. IN THE EVENT OF ANY ILLNESS OR INJURY TO MY CHILD AND AFTER AN ATTEMPT HAS BEEN MADE TO REACH THE PARENTS OR GUARDIAN OF THE CHILD INFORMING THEM OF SUCH INJURY, WILLIE DIGGS BASKETBALL ACADEMY IS HEREBY AUTHORIZED TO CONTRACT FOR AND TO AUTHORIZE TREATMENT BY A MEDICAL DOCTOR.
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