WARRIORS BASKETBALL
PLAYER WAIVER/LIABILITY RELEASE FORM
Players Name (Please print) ______________________
Street Address: ______________________
City: _________________
State: ______ Zip: _________
Phone #: ____________ D.O.B: ___________
Recognizing the possibility of physical injury associated with playing
youth basketball and in consideration Warriors Basketball Academy
accepting this player in their basketball program included in it’s
related activities. I hereby release and discharge Warriors Basketball
Academy, their coaches, associates, sponsors, and administrators
from, any claims, demands, damages and causes of action arising out
of or as a consequence of any injury, damage or loss to the player
incurred while participating in any Warriors Basketball Academy
game, practice or activity.
This release extends to damage or loss arising from transportation to
or from any organizational activity.
My child identified above has received a physical examination by a
physician and has been found physically capable of participating in a
youth basketball program.
I hereby give consent to have a doctor of medicine or dentistry
provide emergency medical assistance and treatment and agree to be
financially responsible for the reasonable costs associated with such
assistance or treatment.
Player’s Signature _______________________
Guardians Printed Name ______________________
Guardians Signature ________________________
Date ______________