los abuelos de oazul · abuelos de costazul, hereby renounce, the right to le any legal claim;...

moo ss mso ád si !n !U

Los Abuelos deMaxibasketball

AzuloC

www.costazulradio.com



AzuloC


I TORNEO INTERNACIONAL DE MAXIBASKETBALL

“PERLA DEL PACIFICO”

LIGA INTERNACIONAL LOS ABUELOS

DE COSTAZUL (L I L A C A)

Rules Acknowledgment: I declare to have received, read and understood each and every one of all the rules given to me by the organizers (LILACA), as well as the written and verbal instructions, that I agree with them, and in case of violations, I could be disqualified or expelled from this tournament.

Age Authentication: It is perfectly clear to me, all players in this tournament must comply

with the rule about their corresponding age from each category or have birthdays during the

same calendar year of this tournament.

LEGAL AND HEALTH / INJURY WAIVER

Name:

Team: Division

Country:

Waiwer: I , as a participant in the 1st MaxibasketballInternational Tournament “Perla del Pacico”, organized by (LILACA) LIGA INTERNACIONAL LOS

ABUELOS DE COSTAZUL, hereby renounce, the right to le any legal claim; judicial,

extrajudicial contractual or extra-contractual, for damages caused by any injury, including

death, incapacity, loss assets or loss of working time, caused by negligence originated from

any active or passive member of the staff, third party workers and ofcials, during the length

of this tournament organized by (LILACA) as well as any sponsor, private medical practitioners

and individuals acting in behalf of the organization during the activities during the tournament,

I declare to have registered voluntarily knowing my physical condition from which I am fully

responsible.

Consent to use images: Hereby I give my consent to the organization committee

of the unconditional right to register, publish and broadcast, by any means: (TV, On line, radio,

newspapers, iers, posters and social media ), the use of my image, name, voice and

biography, with no monetary compensation whatsoever.

I also waive the right to inspect or approve how they are used by the organization.



AzuloC


I agree to show a legal document as proof of age to receive the tournament I.D or credentialsallowing me to participate in this event.

Statement of Fitness and Health: As a Maxibasketball player I declare to be in optimal physical, mental and health conditions, to participate and compete in this tournament and to accept all risks pertaining to training and competition.It is entirely my responsibility any injury, accident or illness, including, partial or permanentdisability and/or death, occurred during this event.

Medical Authorization: In case of wounds or injuries during the competi t ion whileperforming in this event this event, I authorize the medical staff to administer rst aid in case of anemergency and non-emergency situations , and leave to their discretion their professionaldecisions. I hereby waive, the medical staff from any claim and responsibilities due to the factof their involvement of the treatments performed on my body.

I am fully responsible for payment of health insurance including transportation, Doctor's fees andother medical services.The organization (LILACA) is not responsible for any health issues, injuries or illness acquired duringthis event.

** Since February First 2018, Ecuadorian lawmakers imposed an obligatory regulation

to all foreign visitors entering the country, every tourist in the Republic of Ecuador must

acquire a health insurance policy for the length of his/hers stay in the country, this policy

must be procured from an insurance company legally constituted in Ecuador.

(Supplement - Official Registry IV No. 938)

Medical and Health Information: Please respond Yes or No the following Questions.If yes please explain the details.

Have you been diagnosed or treated for the following in the last ve years:

2.

1.

3.

4.

5.

YES NO

YES NO

YES NO

YES NO

YES NO

Hypertension?

Heart and artery disease, heart failure, stroke, aneurysm, atherosclerosis,chest pain, rheumatic fever, cardiac murmur.

Skeletal-muscular or neuro-muscular problems?

Alcohol or substance abuse, mental or neurological disease.

Diabetes or gland disease?.



AzuloC


I certify: to have read, understood and renounced to certain rights and that these have become myresponsibility, that the information given is true.

I will accept the terms and conditions established on this document that I'm voluntarily signing.

I accept and respect the laws of this country (Ecuador), if any controversy arises I will submit

it to the judicial forum in Guayaquil, Ecuador, and renounce any other jurisdiction whatsoever.

Date:(mm) /(dd) /2018

7.

8.

10.

YES NO

YES NO

YES NO

Gain_______lbs Lost_______lbs

6.

9. YES NO

List all prescription drugs being taken at this moment. (Except antibiotics, or contraceptives)

Any allergies to prescription drugs?

Have you lost or gain weight in the last year?

List any surgeries performed during the last ve years.

If yes, list all medications.

Are you pregnant? YES NO

Do you have any unlisted medical condition?

los abuelos de oazul · abuelos de costazul, hereby renounce, the right to le any legal claim;...

Documents