MEDICAL INFORMATION AND RELEASE
Agreement to Participate in Basketball Camp
July 25-28, 2016
Every sport has certain inherent risks, and regardless of the precautions taken, it is impossible to ensure the safety of the participant. Basketball requires a high level of fitness and stamina. They involve quick bursts of speed, long periods of running, and physical contact with a ball and other participants. It is a reasonably safe sport as long as certain guidelines are followed.
Some hazards are the possibility of being struck by the ball, colliding with another player or with goal posts, and poor weather conditions. A variety of injuries occur, including muscle strain, sprains, fractures, contusions, abrasions, and dehydrations. Serious and disabling injuries and even death may result from participation in basketball. It is not possible to list each specific risk.
To help reduce the chance of injury to yourself and other participants, the following safety rules need to be followed during practices and games. Participants will (1) wear the proper protective equipment when they are on the playing field, including mouthpieces, shin pads, and athletic supports, (2) obey the rules of the sport, and (3) report all discovered defects in the playing field.
I agree to follow the preceding safety rules as well as any others given by my coach. Further, I agree to immediately report any unsafe practices, conditions, or equipment to my coach. I also agree to report any injury to the coaching staff on the day that it occurs.
I certify that (1) I am physically fit to participate in basketball, (2) I understand that I am free to discontinue activity at any time I feel undue discomfort or stress, and (3) on the following lines is a complete list of any health-related conditions that might affect my ability to participate in basketball:
I have read the preceding warning of risks, my coach has explained the hazards to me, and I have had the opportunity to ask questions concerning the safety risks involved in basketball. Any questions I have asked have been answered to my complete satisfaction. I fully know, understand, and appreciate the risks inherent in basketball, and I am voluntarily participating in this activity.
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Participant signatureName (please print)
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Parent/Guardian signatureDate
NAME HEIGHTWEIGHT
Last First Middle
ADDRESS
HOME PHONEPARENTS WORK PHONE
DAD’S CELL PHONEMOM’S CELL PHONE
DATE OF BIRTH SEXAGE
NAME OF PARENT OR GUARDIAN
ADDRESS
NAME, ADDRESS, AND PHONE NUMBER OF FAMILY DOCTOR:
List and explain any chronic or acute medical problems.
ALLERGIES:
List all medications being taken at present:
My child has permission to participate in athletics at CommunityChristianSchool, hereinafter referred to as "the Athletic Program. I fully realize that injury or illness to my child could result from or during participation in the Athletic Program. In case of accident or illness, I give permission for my child to receive medical treatment as deemed appropriate. I will assume responsibility for any medical bills other than those covered by the school's insurance program.
Student SignatureParent or Guardian Signature
TRAVEL RELEASE AND HOLD HARMLESS AGREEMENT
Please read carefully before signing
I understand that by signing below, and in consideration of Community Christian permitting my child to participate in the Athletic Program, I agree to release and hold harmless Community Christian School, its faculty, staff, and students, from any loss, claim, demand or cause of action that I or my heirs, executors, or assignees may have, either now or at any time in the future, arising out of or in any way connected with the Athletic Program.
I understand that I am releasing CommunityChristianSchool of liability for all property damage or personal injuries that may sustain while traveling to and from sporting events. I also agree to be responsible for any property damage or personal injuries that my child may cause while traveling to and from sporting events.
Signature of Parent or Guardian