8/3/2019 2011-2012 Boys Basketball Form

http://slidepdf.com/reader/full/2011-2012-boys-basketball-form 1/1

 

6401 Independence Pkwy, Plano, Texas 75023 Tel: 972-491-5800 Fax: 972-208-6482.

2011-2012  BASKETBALL REGISTRATION AND LIABILITY FORM

__________________ ___ _____ _____ _______________________

Participant’s Name Age Jersey # T-Shirt size Home Address(First and Last)

______________ ________________ ________________ ______________

Phone Number Email address Parent’s Name  Parent’s Phone Number

____________________ Paid by: Cash Check  Credit Card$25 Tournament Fee ($40 for new players)

I Would like to participate in following sport event (check one) :Boys 9 – 13 Basketball League Boys 14 - 18 Basketball League Men’s 18+ Basketball League ($250 per team) 

_____________________________Team Name (if any) 

Accident Waiver:I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING AND/OR VOLUNTEERING IN THIS ACTIVITY OREVENT, including any risks that may arise from negligence or carelessness on the part of the persons being released, fromdangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liabilitywithout fault. I acknowledge that this Accident Waiver will be used by the organizers of this event, and that it will govern myactions and responsibilities at said event.

(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from thenegligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft, oractions of any kind which may hereafter occur to me including my traveling to and from this event, THE FOLLOWING ENTITIESOR PERSONS: The Islamic Association of Collin County (IACC) and/or their directors, officers, employees, volunteers,representatives, and agents, the activity or event holders, activity or event sponsors, activity or event volunteers;(B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph fromany and all liabilities or claims made as a result of participation in this activity or event, whether caused by the negligence of release or otherwise.PARENT / GUARDIAN WAIVER FOR MINORS (Under 18 years old)The undersigned parent and natural guardian does hereby represent that he/she is acting and has consented to his/her child orward’s participation in the tournament and has agreed individually and on behalf of the child or ward, to the terms of the accidentwaiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless andindemnify each and all of the parties referred to above from all liability whatsoever which may be imposed upon said partiesbecause of any defect in or lack of such capacity to so act and release said parties on behalf of the minor and the parents or legalguardian. _______________________ ___ _______________________ ______

Print Participant’s Name Age Signature (if under 18 years of age, Date(First and Last) parents or guardians must sign)

Emergency Contact Information: 

_______________________  ___________________

Name (First and Last) Phone Number

_______________________  ___________________

Name (First and Last) Phone Number