Basketball Registration

Cost: $50 / $40 each additional child

Child First & Last Name:*

Date of Birth:*

Current Grade:*

Girls BasketballBoys Basketball

Did you participate last year?:*

Any physical limitations?

Mother's Name:

Mother's Phone Number:

Father's Name:

Father's Phone Number:

Parent Email:

Best Contact Method:

Emergency Contact Name:

Emergency Contact Phone Number:

Release of Liability

As the parent or guardian of {childFirst}, I understand that the risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

FOR MY CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child’s participation; and
I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from participation.
I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Wakefield Youth Rec its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releases from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.
I, the parent/guardian, assert that I have explained to my child/ward: the risks of the activity, his/her responsibilities for adhering to the rules and regulations, and that my child/ward understands this agreement.
I, FOR MYSELF, MY SPOUSE, AND CHILD/WARD, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I have read and agree to all of the above statements:*

YesNo

The Wakefield Youth Rec Committee has a Facebook page that is used as a space to share news, photos and/or videos of people participating in Youth Rec Activities through out the year. Our aim is to document a wide variety of games and events. We are committed to maintaining objectivity, ensuring that we represent as many participants as possible.

As a parent/guardian, I recognized my child(ren) may be posted online as they participate in Youth Rec sponsored activities.*

YesNo

The Wakefield Youth Recreation Committee supplies each team with the necessary tools, equipment, and jerseys to ensure a successful season. To help keep registration costs affordable, all items must be returned at the end of each sport. Failure to return these items will result in an additional charge to cover the cost of the missing equipment.

As a parent or guardian, I acknowledge my responsibility to reimburse the Wakefield Youth Recreation Committee for any items that are not returned or are lost.*

YesNo

Signature*

Date

Youth Registration

Volunteer Deposit