Biddy Basketball League

P.O. BOX 9160

PHILADELPHIA, PA 19139

267-808-7277

Pee Wee Division 5-8years old: ______Freshman Division 9-10 years old: ______

Junior Division 11-12 years old: ______

Player’s Information

Name:
Date of Birth: / Age: / Male: Female:
Address:
Home Phone: / Cell: / Email:
Shirt Size:
Medical Insurance Information:
Physician: / Address: / Phone:

Medical Conditions/Allergies/Medications

Parents/Guardians Information

1.Name:
Address:
Phone: Cell: Work:
Email:
2.Name:
Address:
Phone: / Cell: / Work:
Email:

Emergency Contact

Name and Relationship to Child / Address / Phone
1.
2.
Parents/Guardians Signature
1. / Date:
2. / Date:

Biddy Basketball League

Waiver & Release Form

Waiver: (Philly Hurricanes Biddy Basketball League) Its employees, agents or volunteers assume no liability for injuries or damages arising or resulting from participation unless due to willful fault or gross negligence on the part of the employees or volunteers. Due to the strenuous nature of some activities, the participant is urged to consult a physician concerning fitness to participate. All activities present certain inherent risks and hazards which the participant and the parent/guardian are urged to consider. I hereby approve my child’s participation in all camp activities. To the best of my knowledge, the participant is medically fit to participate. Being fully aware of the risks and hazards inherent in activities relating to camp, I hereby authorize my child to participate in said activities. I voluntarily assume all risks of loss, damage, or injury that my child may sustain while participating. I hereby authorize PHBBLto seek immediate medical treatment for the chil listed, if a medical emergency arises while she/he participates. I hereby release Director Maurice Davis, PHBBL, and all persons connected with said activities from my child’s participation.

Refund Policy: If I need to withdraw my child PRIOR to the camp beginning, AND if and only if PHBBL can fill my space, then I understand I may receive a refund of the tuition minus a $50.00 administrative fee. I also fully understand that once sessions begin, there are absolutely no refunds in the event my child must withdraw from or misses any days. Also, if my child is inappropriate during camp and represents a danger to other children, PHBBL reserves the right to remove him/her without refund.

As a condition of this application being accepted, we acknowledge that digital photographs and videos may be taken during any session and we give PHBBL, permission photograph and video record the Players named on this application with respect to league activities and the irrevocable and unrestricted right to use and publish photographs of them, or in which they may be included, for editorial, trade and advertising, and in any manner or medium, without compensation. We also hereby release Photographer and his/her legal representatives and assigns from all claims and liability relating to said photographs.

EMERGENCY AUTHORIZATION: I hereby authorize PHBBL Staff to obtain and consent to emergency medical treatment for my child while under their care in the event they are unable to contact me or the listed emergency contacts.

I also certify that I have read, understand and agree to the refund policy. This Release, Defend, Indemnification and Hold Harmless Agreement MUST BE SIGNED BY A PARENT/GUARGIAN. THIS IS A LEGALLY BINDING AGREEMENT.

Parent/Guardian

Print: ______

Signature: ______Date: ______