THE PATRICK WILLIAMS FAMILY FOUNDATION REGISTRATION FORM PATRICK

By completing this form you acknowledge that you're giving up certain legal rights and hereby represent and warrant to the : (1) You are over the age of majority in your jurisdiction of residence. (2) You are registering on behalf of a minor and are his/her parent/legal guardian and as such are fully authorized and entitled to enter into this agreement on his/her behalf. Please note this agreement requires you to read the Program Agreements on pages 5 and 6. Please provide your email address below to receive your registration confirmation, newsletters and information guide!

IN ORDER FOR REGISTRATION FORMS TO BE PROCESSED, ALL SECTIONS MUST BE COMPLETED.

The safety of each individual in the program is of the utmost importance to the recognize a personal responsibility to learn and follow at all times the safety and other rules established by staff. I hereby agree that any behaviour of the registrant that places him/herself or others at risk may result in the registrant's immediate dismissal from the program. Further, if dismissed from the program, I agree to cover any expense(s) arising from such dismissal. I hereby acknowledge and agree that no refund will be granted for dismissal or removal of the registrant at his/her request before the end of a program session. In order to ensure the safety and well-being of all individuals participating in the program, the reserves the right to alter the program at any time without notice or compensation to the Registrant.

I have read and understand the Code of Conduct. Signature

Are there any court orders or custody restrictions which would prevent us from communicating with either parent/guardian? If yes, we will contact you for additional information

HEALTH HISTORY AND PERSONAL INFORMATION

The more information you can provide, the better we can meet the needs of your child. This information will be used by the Day Camp/Childcare Director, and your child's counselors to support your child. If there is additional information of a sensitive nature, please feel free to send a separate letter marked 'confidential' to the attention of the Day Camp or Childcare Director. Whatever information you send to us will be treated with confidence and respect. We encourage, but do not require, a medical

Is the participant under any form of treatment for an illness, condition or injury?No Yes

f yes, please explain and detail routines, medications, adaptations etc. We also require you to complete a Medication Dispensing

Does your child require 1-1 support while at camp?Yes

If yes, please make sure you have filled out the online inquiry form and connected with us, prior to filling out this registration

form. If you have not, please email us and we will send you the link to the inquiry form

Yes Does your child have any medical or behavioural conditions that we should be aware of?No

Does your child use a puffer? Yes

Wears Medic-Alert Bracelet: Yes

Dietary needs or restrictions (please provide details below):

PURPOSES: For marketing, advertising, promotional and/or communication purposes, the Patrick Williams Family Foundation(PWFF) may, from time to time, take photographs and/or video recordings of sports based activities or events that include real people, which photographs and video recordings may be placed on the foundation's website and/or social media platforms which may be used by PWFF for its own informational, promotional or advertising purposes, and by any other person authorized by PWFF (an "Authorized Third Party") to use such photos or video recordings, in any part of the world, in connection with such Authorized Third Party's support for, association with, or arrangements with, PWFF (collectively, the "Purposes"

By signing this Form, you are consenting to the taking of photographs and/or video recordings of you by the The Patrick Williams Family Foundation for the Purposes, you are assigning to the The Patrick williams Family Foundation, and waiving any rights you have related to, any such photographs and/or video recordings, and you are consenting to the use of any such photographs and/or video recordings, in whole or in part, by the The Patrick williams Family Foundation and any Authorized Third Party for the Purposes For valuable consideration received but without any promise of remuneration, I hereby agree to allow photographs and/or video recordings to be taken of me, whether posed or candid, while I am on West Charlotte High School property and/or participating in PWFF activities or events, to be reproduced, published, displayed, broadcast, transmitted, licensed, sublicensed or otherwise used by PWFF or any Authorized Third Party in connection with the Purposes, including without limitation on internet web sites, in printed materials, or in any other materials or medium whatsoever and wherever (the "Work Product" I confirm that neither the PWFF nor any Authorized Third Party shall be obligated to use the Work Product. I understand that the Work Product is being created under the direction and control of PWFF. I hereby irrevocably assign to PWFF any and all rights, including copyright, financial or other rights, and I hereby irrevocably waive in favor of PWFF and any Authorized Third Party any and all moral rights or rights of similar nature that I may have in the Work Product. I agree that the has the sole worldwide ownership and rights in and to the Work Product, including copyright interests, and I acknowledge that I have no interest or ownership in the Work Product or its copyright. I agree that I will not bring or consent to others bringing a claim or action against PWFF on the grounds that anything contained in the Work Product, or in the manner in which the Work Product is used, is defamatory, reflects adversely on me, or violates any other right whatsoever, including, rights of privacy and publicity. I hereby release and forever discharge PWFF, any Authorized Third Party and their respective officers, directors, employees, agents, partners and affiliates, and their respective heirs, executors, personal legal representatives, successors and assigns, as applicable, from all actions, claims, causes of action, suits, demands, liabilities and damages whatsoever, in law or equity, which I may have against any of them in connection with the Work Product. I confirm that I am over the age of majority in my province or territory of residence and am competent to execute this Form and to participate in the development of the Work Product; or, to the extent that I am under the age of majority in my province or territory of residence, have had my parent or guardian review this Form and consent to my participation in the creation of the Work Product on my behalf. Any inconsistency between this Form as expressed in English and any other language shall, to the full extent permitted by applicable law, be resolved by reference to the English version.

By signing my name, I (and my legal guardian, where applicable) acknowledge that I (or we) have carefully read and understand

ASSUMPTION OF RISK AND INDEMNIFYING RELEASE

While PWFF staff and instructors will make every reasonable effort to minimize exposure to known risks associated with each Registrant's (defined below) participation in a basketball summer camp program ("Program"), I hereby acknowledge that I and/or my child if I am registering on his/her behalf (collectively, the "Registrant") may be required, depending on the nature of the Program, to participate in various physical activities that may involve risk of injury. In this regard, I agree that I have provided (if required) a complete and accurate health history and hereby permit the Registrant to participate in the full range of Program activities, except as specifically noted by me in the health information section of the Program registration (where applicable In consideration for the Registrant's opportunity to participate in the Program, the receipt and sufficiency of which is hereby acknowledged, I hereby release and forever discharge the Patrick Williams Family Foundation of Charlotte, North Carolina, its respective officers, directors, employees, volunteers and agents, and their respective successors and assigns, from any and all liability for damages sustained in consequence of loss, injury or damage to the Registrant, and from all other actions, causes of action, claims, demands or damages of any kind with respect to death, injury, loss or damages to any person or property arising out of or connected with preparation for, or participation in, the Program.

In the event of an accident, injury or illness involving the registrant, and immediate contact by the with a designated contact cannot be made, I hereby authorize and grant permission to Patrick Williams Family Foundation staff to secure proper medical treatment and authorize on the registrant's behalf all procedures, including, without limitation, admission to an emergency unit, hospital and treatment therein, ordering of x-rays, tests or treatment, injections, anesthesia and/or surgery, as deemed necessary by the attending medical professional(s I agree not to hold the responsible for any costs or injury arising out of an emergency situation.

The Patrick Williams Family Foundation of Charlotte, NC is committed to protecting personal information by following responsible information handling practices. We collect and use information you volunteer when you access or register for a basketball summer camp program, in order to better meet your service needs, to ensure a safe environment, for statistical and assessment purposes, to inform you about the Program in which you are registered, and to satisfy government and regulatory requirements. You may also hear from us periodically about other Patrick Williams Family Foundation programs, services and opportunities that may interest and benefit you.

By signing my name, I (or my legal guardian) acknowledge that I (or we) have carefully read and understand the, Assumption of Risk and Indemnifying Release Statement, Medical Emergencies Statement, Commitment to Privacy Statement and Disclaimer.