Classics Basketball Liability Waiver And Consent For Medical Treatment (Return To Your Coach/team Manager)
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1Classics Basketball
Liability Waiver and Consent for Medical Treatment
(Return to your Coach/Team Manager)
Player Name:_______________________________________________ Birthdate:_______________
Address:___________________________________________________________________________
Address:___________________________________ _____________ _____________
(City)
(State)
(Zip)
Home Phone:________________________
Cell Phone: _________________________
Parent Name(s):_______________________________
_______________________________
(Father)
(Mother)
Cell/Emergency Phone:________________________________
_______________________________
(Father)
(Mother)
Health Insurance Provider: ________________________________________Phone#:___________________
Insurance ID #:________________________________ Group #:________________
Health Conditions/Medications/Allergies: _____________________________________________________
Liability Waiver: Basketball presents certain inherent risks and hazards, which the Player-participant and
parent/guardian are urged to consider and which the Player assumes. To the best of my knowledge, there are no
physical or other health-related conditions, which will interfere with my child’s participation unless noted above.
I, the undersigned parent/guardian for the above named Player, understand and acknowledge that such
recreational activities have inherent risks, dangers and hazards, foreseeable and unforeseeable, that may result in
injury, illness, or property damage, and on behalf of myself, my family, agents and contractors, I hereby release
and agree to hold harmless Classics Basketball, Inc., it sponsors and its AAU registered volunteer coaches,
managers, club officers and directors, from all claims, actions, or losses related thereto. Classics Basketball, Inc.,
assumes no liability for injury or damage arising from the results of participation of the above Player unless due
to willful fault or gross negligence on the part of Classics Basketball, Inc. I also agree that my child will be a
registered AAU member with Added Benefit Insurance coverage.
Medical Treatment Release: Due to the strenuous nature of basketball, the Player participant is urged to consult
her physician concerning her fitness to participate. I, the undersigned parent/guardian for the above named
Player hereby approve of my child’s participation in the Classics Basketball program and consent to emergency
medical treatment for my child on my behalf. I also authorize any AAU-registered adult of Classics Basketball to
obtain any necessary medical treatment for my child on my behalf, in case of an emergency, where I am not
present and with the understanding that I will be notified as soon as possible. My health insurance information
has been provided above.
Parent Signature:______________________________________________ Date:_______________
Coach or Team Manager will have a copy of this form at all practices and games.
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