Guardian Name *

First Name

Last Name

Phone *

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Scholar-Athlete Name *

First Name

Last Name

What services are you interested in? *

Skills Clinics

Camps

Personal Training

Club/Development Teams

I understand the description of the activity for which we are registering, and in consideration for being permitted by the City Roots Basketball Club to participate in the above activity, I hereby waive, release and discharge any and all claims for damages for personal injury, death or property damage which I may have, or which may hereafter occur to me as a result of participation in said activity. It is understood that this activity involves an element of risk and danger of risk and danger of accidents and knowing those risks I hereby assume those risks. It is further agreed that this waiver, release, and assumption of risk is to be binding on my heirs and assigns. I agree to indemnify and hold the City Roots Basketball Club free and harmless from any loss, liability, damage, cost or expense that they may incur as a result of my son’s/daughter’s death or any injury or property damage he or she may sustain while participating in the above-said activity. I hereby consent that my son/daughter participate in the above activity, and I hereby execute the above agreement, waiver, and release on his or her behalf. I state that the above-said minor is physically able to participate in the above-said activity. I hereby agree to indemnify and to hold the City Roots Basketball Club mentioned above free and harmless from any loss, liability cost damage, or expense which they may incur as a result of the death or any injury or property damage that the said minor might sustain while participating in above said basketball activity. I have carefully read the agreement, waiver, and release form fully and understand its contents. I am aware that this is a release of liability and a contract between myself and the City Roots Basketball Club and I sign it of my own free will. *

I Agree

I give permission for my child to participate in all activities associated with the City Roots Basketball Club. Furthermore, I authorize the City Roots Basketball Club to arrange transportation in case of an accident or acute illness of my child. In the event it is impossible to receive instruction from me for my child’s care, consent is given to any licensed physician and/or surgeon called to whom my child is taken for treatment by him to administer drugs and/or medication and to perform surgical treatment as he shall think the existing emergency requires for the relief of pain and/or preservation of my child’s life and/or health and well-being. Any cost addition, I agree to waive and release the City Roots Basketball Club from any and all claims, costs, liabilities, expenses or judgments, including attorney fees and/or court costs arising out of the participation of the above-named minor in the basketball camps/programs or any illness, accident or injury resulting from the said activity and hereby agree to indemnify and hold harmless the City Roots Basketball Club from and against any and all such claims. *

I Agree

Athlete Agreement *

I learned about concussion and talked with my parent or coach about what to do if I have a concussion or other serious brain injury.

Parent/Guardian Agreement *

I have read the information above for parents on concussion with my child or teen and talked about what to do if they have a concussion or other serious brain injury.

I acknowledge that I fully understand the risks associated with participating in the sport of basketball. I have carefully read this agreement and provided all required information to the best of my knowledge. *

I hereby give my full consent for my son/daughter to participate in all activities with City Roots Basketball Club. I understand the inherent risks involved in the sport of basketball and, on behalf of my child and myself, release and hold harmless City Roots Basketball Club, its coaches, staff, and affiliates from any liability, claims, or demands arising from participation.