Bridge City Inclusive Sports
Waiver and Release
Athlete Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
I, undersigned, agree with the following statements:
I acknowledge that wheel chair basketball is an extreme test of a person's physical and mental limits and that I am in proper physical condition to participate in this activity.
I fully understand that (a) WHEELCHAIR Sports activity (the“Activity”) INVOLVES RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING CONCUSSION, DEATH AND POSSIBLE EXPOSURE TO AND ILLNESS FROM INFECTIOUS ANDCOMMUNICABLE DISEASES (INCLUDING, BUT NOT LIMITED TO, COVID-19 AND MUTATIONS ORVARIATIONS THEREOF) AND OTHER SIMILAR VIRUSES OR INFECTIONS WHETHER NOW KNOWNOR LATER DISCOVERED AND PROPERTY DAMAGE (collectively, "Risks"); (b)these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in Wheelchair Basketball, the conditions in which the activity takes place, or THE NEGLIGENCE OF THE"RELEASEES" NAMED BELOW; (c) there may be OTHER RISKS or SOCIAL ANDECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES,COSTS, AND DAMAGES I incur as a result of my participation, or that of the minor, in the Activity.
I ON BEHALF OF MYSELF, MYEXECUTORS, ADMINISTRATORS, HEIRS, NEXT OF KIN, SUCCESSORS AND ASSIGNS, HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE the BRIDGE CITY INCLUSIVESPORTS-ROLLING BLAZERS, camp directors, sanctioning organization(s), their administrators, directors, agents, officers, members, volunteers, and employees, other participants, officials, rescue personnel, sponsors, advertisers, owners and lessees of premises on which the Activity is conducted,(each of the forgoing shall be considered one of the “RELEASEES” herein) FROMALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED, ORALLEGED TO BE CAUSED, IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OROTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS; AND I FURTHER AGREE that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITYAGREEMENT I, or anyone on my behalf, makes a claim against any of the Releases, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may be incurred as the result of such claim.
PUBLICITY RELEASE-I hereby agree to be filmed, videotaped and photographed, and to have my name, image, picture, likeness, voice and biographical information (collectively, “Footage”) otherwise recorded, in any media by the BRIDGECITY INCLUSUVE SPORTS-I hereby grant BRIDGE CITY INCLUSIVE SPORTS with no financial or other compensation due to me, full right and license to use, and to authorize third parties to use, in all media, the Footage for: (1) news and information purposes, (2) promotion of the specific competition(s) in which I compete, (3) promotion of the Sport, and (4) promotion of the BRIDGE CITY INCLUSUVE SPORTS
If, during my participation in the Activity, I should needemergency medical treatment, and I am not able to give my consent or make myown arrangements for that treatment because of my injuries, I authorize BRIDGE CITY INCLUSIVE SPORTS to take whatever measures are necessary to protect myhealth and well-being including, if necessary, hospitalization.
I hereby certify that the information provided is beingprovided directly by myself for, or if representing a minor as a legalguardian, and that it is true and accurate to the best of my knowledge. I alsounderstand that the false information is grounds for denial ofmembership. I HAVE READ THIS WAIVER AND RELEASE. I FULLY UNDERSTAND THEPROVISION OF THE RELEASE THAT I AM AGREEING TO. I UNDERSTAND THAT BY CLICKINGTHE BOX BELOW, I AM SAYING THAT I AGREE TO THE PROVISIONS OF THIS RELEASE.
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Signature of Athlete or Parent of Athlete under the age of 18
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