GSG Clinic Waiver Form

1
Which location are you participating in?* This field is required.Choose from the drop down menu below:
Please Select
Please Select
Martinez, CA - Boys & Girls Club of Contra Costa
Richmond, CA - West County Salesian Youth Club
Sacramento, CA - Kennedy High School
2
Player's Name* This field is required.
First Name
Last Name
3
Choose the gender of the player:* This field is required.Select option below.
Male
Female
4
What grade is the player in?* This field is required.Using the 2024-2025 school year, what grade is the player enrolled in?
3rd grade or younger
4th grade
5th grade
6th grade
7th grade
8th grade or older
5
Player's Birthdate* This field is required.Click on the month/year on the top left to quick scroll
Date
Year
Month
Day
6
Parent/Guardian Information* This field is required.Please complete your contact information below.
First and Last name
Cell Phone Number
7
E-mail Address* This field is required.
8
How did you hear about the Basketball clinic?Select an option below or click "Next" to skip to the next question.
Google/Search Engine
A Friend or Colleague
Social Media/Facebook/Instagram/Twitter
School
West Contra Costa Salesian Boys & Girls Club
Boys & Girls Club of Contra Costa
Other
9
Medical Conditions (If Applicable):Please list below any medical conditions and/or allergies that you think we should know about (or click "Next" to skip to the next question):
10
AGREEMENT/WAIVER* This field is required.SCROLL ALL THE WAY DOWN TO ACCEPT THE AGREEMENT/WAIVER. I hereby waive, release and discharge any and all claims for damages for the personal injury, death, or property damage which I may have, or which hereafter accrue to me or my child, as a result of participation in basketball practices and/or basketball competitions in all its forms. The release is intended to discharge in advance, the organization (Golden State Games, Events & Services), it’s coaches or volunteers from any and all liability arising out of or in any way connected with my participation in said activity. Its understood that the activity involves an element of risk and danger of accidents and knowing those risks, I assume those risks. It is further agreed that this waiver, release, and assumption of risk, is to be binding on my heirs and assigns. I agree to indemnify and to hold Golden State Games, Events & Services, all persons and entities associated with (Golden State Games, Events & Services), free and harmless from any loss, liability, damage, cost or expense, in which they may incur as a result of death, injury or property of damage that I may sustain while participating. I also give Golden State Games, Events & Services, it’s coaches or volunteers the right to copyright and/or publish, reproduce, or otherwise use my child’s name, voice, and likeness and/or photographs, and audiovisual recordings that include my child for instruction, advertising, program website, publications or brochures, or any other lawful purpose whatsoever. I hereby agree to relinquish all rights, title and interest I may have in the finished product and waive all rights to any compensation thereof. I hereby consent that my child may participate in the above activity, and hereby execute the above agreement, release and waiver on his behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any loss, liability, damage, cost, or expense, which may arise or may be incurred as a result of death, injury, or property damage that said minor may sustain while participating in said activity. I further expressly acknowledges that the foregoing agreement, waiver, and release form is intended to be as broad as is permitted by the laws of the State of California and that if any portion thereof is held invalid, it is agreed that the balance notwithstanding, continue in full legal force and effect. Undersigned agrees that no oral representations, statements or inducements apart from the foregoing written agreement have been made. I HAVE READ THE FOREGOING RELEASE, I FULLY UNDERSTAND IT, AND I AGREE TO BE BOUND BY IT.
I/We agree with the above.
11
Signature Required* This field is required.By signing below you agree to the previous waiver agreements
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