Clone of Border Town Basketball Tryout Registration and Waiver

Player's Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth

Birthdate

Gender

Grade - Please enter just the number ex. 4,5,etc...

Border Town Basketball Tryouts

Past Organized Basketball Experience

Parent/Guardian Name

First NameLast Name

Parent/Guardian Email

example@example.com

Parent/Guardian Best Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Medication/Medical Conditions (if none, enter NA)

Emergency Contact (other than parent listed above)

First NameLast Name

Emergency Phone Contact (other than parent listed above)

Please enter a valid phone number.Format: (000) 000-0000.

Release and Waiver:

I HEREBY RELEASE, WAIVE AND FOREVER DISCHARGE the Bordertown Basketball (BTB), Bavubuka Foundation(BV) and all other associations, coaches, event organizing bodies, sanctioning bodies, and sponsoring companies and all their respective agents, officials, servants, contractors, representatives, successors and assigns OF AND FROM ALL claims, demands, damages, costs, expenses, actions and causes of action, whether in law or equity, in respect to death, injury, loss or damage to the applicants person or property, HOWEVER CAUSED, ARISING OR TO ARISE by reason of the applicants participation in this program whether as a spectator, participant, competitor or otherwise, at any time. AND NOT WITHSTANDING that same may have been contributed to or occasioned by negligence of any of the aforesaid.

This agreement shall bind my heirs, executors, assign, and representatives. I FURTHER HEREBY UNDERTAKE TO HOLD AND SAVE HARMLESS and AGREE TO INDEMNIFY all the aforesaid from and against any and all liability incurred by any or all of them arising as a result of or in any way connected with the applicants participation with the BTB and BV.

I hereby authorize the BTB and BV to act for me according to their best judgement in any emergency requiring medical attention. I hereby authorize the designated physician to perform such diagnostic, medical and/or surgical treatment on my child as may be deemed medically necessary in order to assure the safety of my child. I understand I will be financially responsible for any medical attention needed during the session.

I WARRANT that the applicant is physically fit to participate in and be involved in the basketball program.

I hereby agree that my name and photograph may be used in associated photographs for BTB and BV promotional material.

BY SUBMITTING THIS FORM, I ACKNOWLEDGE HAVING READ, UNDERSTOOD, AND AGREED TO THE WAIVER, RELEASE, AND INDEMNITY.

Parent/Guardian Signature

Date

BTB Tryout Registration and Waiver