WAIVER, CONSENT TO TREAT, AND PHOTO/VIDEO/SOUND RELEASE FORM
I am fully aware that in registering my child for participation with Sean Stewart Sr, I will be waiving and releasing all claims for injuries my child may sustain arising out of the program. I recognize and acknowledge that there are certain risks of physical injury inherent in participation in the sport of basketball and I agree to assume the full risk of any such injuries, damages, or loss regardless of severity which I or my child may sustain as a result of participating in this program. I hereby fully release and discharge Sean Stewart Sr., staff, volunteers, and any other stakeholders that are affiliated, from any and all claims resulting from injuries, damages, and losses sustained by me or my child, and arising out, connected with, or in any way associated with the activities of the program.
I authorize the coaches and/or medical personnel to arrange for or render care in any emergency, including Aid Car, EMS, or emergency room transportation, and consultation or treatment by a medical professional or specialist. I understand that every effort will be made to contact me beforehand regarding medical treatment of participant. I accept full responsibility for the cost of treatment and do hereby release and discharge Precision Basketball, its staff, and volunteers, from any and all claims of injury, losses, or damages suffered by the participant during basketball-related activities.
I consent that my child's image, and likeness, as shown in videotapes and photographs for which he/she posed, and/or audio recordings made of his/her voice may be used by the Precision Basketball, in whatever way it desires; furthermore, I hereby consent that such photographs, films, recordings, and/or electronic images, and the plates, tapes, and/or software from which they are made shall be Precision Basketball's sole property, and Precision Basketball shall have the right to sell, duplicate, reproduce and make other uses of such photographs, films, recordings, electronic images, plates, tapes, and software as they may desire, free and clear of any claim whatsoever on my part.
Print Player Name ____________________________________________
Signature of Player ____________________________________________ Date________________________
Print Parent/Guardian Name______________________________________
Signature of Parent/Guardian Name________________________________ Date________________________
Insurance Name and Number_____________________________________
Doctor's name and Number_______________________________________
Medical/Health issues: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________