YOUTH BASKETBALL TEAM ROSTER – POCATELLOPARKS & RECREATION
Kid’s Basketball 8th Grade Girls Basketball
Team Name______Coach’s Name______
Address______City______State______Zip______
Phone: Home______Cell______Work______E-mail______
I have carefully read the agreement, waiver, and release form and fully understand it contents. I am aware that my signature constitutes a release of liability and a contract between myself and the City of Pocatello Parks and Recreation Department.
Receipt # / Player's Name / Parent's Signature / Phone / Number(s) / Address / City / Zip(Please Print) / Home/Cell / Work
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AGREEMENT WAIVER and RELEASE ATHLETIC LEAGUE
In consideration for my child being permitted by the City of Pocatello Parks & Recreation Department to participate in an athletic league involving the sport on the reverse side of this form, I do hereby for myself, my heirs, executors, administrators, successors, and assigns, waive, release, acquit, and forever discharge the City of Pocatello, its employees, School District #25, contracted game officials, or other persons whose services are contracted for in connection with the above stated program from any and every claim, demand, right, or cause of action, property damage, personal injury, costs, expenses of any kind, and any compensation whatsoever, which I may ever assert by reason of my minor child's presence and/or participation in said program.
I understand that the sport listed on the reverse side of this form may be of a hazardous nature and/or include physical and/or strenuous exercise or activity; that serious accidents occasionally occur during the above sports activity; and that participants in this sports activity occasionally sustain mortal or personal injuries and/or property damages as a consequence thereof. Knowing the risks involved, nevertheless, I have voluntarily applied to participate in said activity and I hereby agree to assume for my minor child any and all risks of injury or death and to release or hold harmless the City of Pocatello (its officers, employees, and agents) who might otherwise be liable to me or my minor child.
I further agree to indemnify and to hold the City of Pocatello (its officers, employees, and agents) and all entities (and their officers, employees and agents) that provide facilities for the sport listed on the reverse side of this form stated program, free and harmless from any loss, liability, damage, cost, or expense which they may incur as a result of any injury and/or property damage that I or my minor child may sustain while my minor child is participating in said activity.
I understand that I am responsible to provide my own health and accident insurance in the case that my minor child is injured while participating
in the sport listed on the reverse side of this form.
I have the choice to agree/disagree to allow my child’s personal information to be released to local basketball camp organizers or other basketball related organization mailing lists by circling the Yes or No in the information release section.