D.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet

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1 D.M.G. Athletics Presents The Official Indoor/Outdoor Summer Basketball League Team Registration Packet Questions: Contact Coach Dawne Gittens at or via at

2 Team Name Age Division (Circle One) Team s (12 s Max) TEAM REGISTRATION FORM Elementary/ 9U Middle/ 13U High School/ 18U Name of Birth Age Name Best Contact # Coach/ Team Administrator Information: I/we agree to remit all payments in a timely manner as outlined below and that any payments that are missed are subject to suspension of your child s eligibility. Furthermore, I/we agree to be responsible for any cost of collection including reasonable attorney fees. Once uniforms are ordered, NO REFUNDS WILL BE MADE. ALL MONIES COLLECTED WILL BE FORFEITED TO THE Boys & Girls Clubs of Hartford. Total cost is $275 per team; Individual s $40 Coach Signature *Each player must have the attached waivers completed.*

3 Youth Basketball Program PERMISSION AND AUTHORIZATION FORM Name: of Birth: Street Address: City, State and Zip Code Telephone Home: Work: Cell: Personal: Work: Parent(s) Name: Physician s Name: Dentist s Name: Health Insurance Name: Emergency Contact: Policy Number: I hereby give permission for my child to participate and play in the Boys & Girls Clubs of Hartford (BGCH) Youth Basketball Program. I understand that the sport of basketball can involve contact with other players and the possibility of injury doe exist. In the event of an emergency requiring medical attention, and I am unavailable, I authorize the coach, assistant coach or any other BGCH Youth Staff to act on my behalf, according to their best judgment. I have no knowledge of any physical impairment that would be affected by my child s participation in this sport. I hereby waive and release the Boys & Girls Clubs of Hartford and its coaches, Directors and staff from any and all liability for injuries or illnesses incurred to, from or during the practices and or games. I understand and permit the Boys & Girls Clubs of Hartford retain the rights to use photographs of players and coaches taken during sporting events for publicity or advertising purposes. Parent or Guardian Signature

4 Youth Basketball Program ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM I acknowledge that this athletic event is an extreme test of a person s physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limit to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to athletics, but are also present for volunteers. I hereby assume all of the risks of participating and/or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them or because of their possible liability without fault. I certify that I am physically fit, have sufficiently trained for participation in the event and have not been advised otherwise by a qualified medical person. I acknowledge that this Accident Waiver and Release from Liability form will be used by the event holders, sponsors and organizers, in which I may participate and it will govern my actions and responsibilities at said events. In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to me including my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: Boys & Girls Clubs of Hartford their directors, officers, employees, volunteers, representatives, and agents, the event holders, event sponsors, event directors, event volunteers; (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this event, whether caused by negligence of releases or otherwise. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and or illness during the event. I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers and or assigns. This Accident Waiver and Release of Liability shall be constructed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I hereby certify that I have read this document; and, I understand its content. Print Participant s Name Age Signature (If under 18, parent/guardian must sign) PARENT/GUARDIAN WAIVER FOR MINORS (Under 18 years old) The undersigned parent and/or natural guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and indemnify each and all of the parties referred above from all liability, loss, cost, claim or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the minors and the parents or legal guardian. Print Parent or Guardian Name Signature of Parent or Guardian

5 HOLD HARMLESS AGREEMENT This Hold Harmless Agreement must be completed and signed by each individual participating on a team utilizing a City Park, (the Premises ) for an athletic event. PLEASE PRINT: Participant,, hereby agrees that it shall, at all times defend, and indemnify, protect and save harmless the City of Hartford and its officers, agents, and employees from and against any and all liabilities, actions, claims, damages, losses, judgements, costs and expenses (including but not limited to attorneys fees) arising out of injuries to any person, party or entity, that may arise as a result of any occurrence, negligence or otherwise during the Applicant s use of the Premises. Signature of Participant Print Parent or Guardian Name Signature of Parent or Guardian This Agreement must be received at least ten (10) days prior to the date the use of the Premises.