Hang Time Hoops Basketball Camp
Fab Four Sports LLC
AUTHORIZATION, WAIVER AND HOLD HARMLESS AGREEMENT
(“AGREEMENT”)
I, ______________________________, certify that I am the parent or legal guardian of
____________________________, who is a minor. I give my permission and consent for
my child to attend Hang Time Hoops Basketball Camp operated by Fab Four Sports
LLC.
I am aware that normal and usual basketball related activities have certain inherent risks
and may cause injury and death to participants. I understand the nature of the activities in
which my child will participate at Hang Time Hoops Basketball Camp.
To the best of my knowledge, except as stated below, my child is in good physical and
mental condition and I have no knowledge of any physical or mental condition, injury, or
illness whatsoever that would place my child at risk to participate in the camp's programs
and activities. I have been fully informed of all of the camp’s programs and activities. I
will notify the Hang Time Hoops Basketball Camp directors should I become aware of
any physical or mental condition arise that may place my child at risk. I hereby give my
unqualified permission and consent for my child to participate in the activities, subject
only to any specific limitations noted below.
Prohibited Activities: As a result of the medical condition(s) described below or
for other reasons, I do not want my child to engage in any of the following
activities (describe in reasonable detail; use an additional sheet if necessary):
_________________________________________________
_________________________________________________
While my child is attending the camp, I give permission for the staff of Hang Time
Hoops Basketball Camp to administer any and all medical attention and treatment to my
child that any of the staff, in good faith, deem appropriate in the event of any accident,
illness, or injury. I will be responsible for any and all costs of medical care and
treatment that may be provided, except for care and treatment covered by my insurance.
Medical Conditions: My child is subject to the following allergies or medical
conditions, and I authorize the camp to disclose such allergies and medical
conditions to a physician or other health care provider in the event that my child
should require emergency medical care (describe allergies or medical conditions
in reasonable detail; use additional sheet if necessary):
____________________________________________________
____________________________________________________
I hereby agree to release, waive, discharge and covenant not to sue Hang Time Hoops
Basketball Camp, Fab Four Sports LLC, The Perkiomen School, along with their
respective officers, directors, board members, supervisors, agents, servants and
employees (collectively the “Releasees”) from any and all liabilities, claims, demands, or
causes of action that may arise from or be related to any loss, damage, or injury,
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Hang Time Hoops Basketball Camp
Fab Four Sports LLC
including death, that may be sustained by my child or my child's personal property while
my child is participating in the camp's programs or activities or while my child is on the
premises on which the camp is located, EVEN TO THE EXTENT ARISING OUT OF
THE NEGLIGENCE OF ONE OR MORE OF THE RELEASEES.
I voluntarily assume full responsibility for any risk of loss, property damage, or personal
injury, including death, that my child may sustain as a result of participating in the camp's
programs and activities, however caused. I further agree to indemnify and hold harmless
the Releasees from any and all loss, liability, damage and cost, including court costs and
attorneys' fees, that may accrue related to my child's participation in the camp's programs
and activities or presence on the premises on which the camp is located, however caused,
EVEN TO THE EXTENT ARISING OUT OF THE NEGLIGENCE OF ONE OR MORE OF
THE RELEASEES.
This Agreement is binding upon my and my minor child’s heirs, administrators,
executors, legal representatives, successors and assigns. The provisions of this
Agreement shall continue in full force and effect even after the termination of the
activities conducted by the camp for so long as is necessary to fulfill the intent hereof.
This Agreement is governed by the laws of the State of Connecticut without regard to its
principles governing conflicts of laws and is intended to be as broad and inclusive as is
permitted by those laws. If any provisions of this Agreement are held invalid or
unenforceable by a court of competent jurisdiction, the remaining provisions shall
continue to be fully effective.
I HEREBY CONSENT TO THE EXCLUSIVE JURISDICTION OF THE COURTS OF THE
STATE OF CONNECTICUT FOR THE PURPOSES OF ALL LEGAL PROCEEDINGS
ARISING OUT OF OR RELATING TO THIS RELEASE AND THE TRANSACTIONS
CONTEMPLATED HEREBY. I FURTHER HEREBY IRREVOCABLY WAIVE AND
RELEASE, TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, (I) ANY
OBJECTION TO THE VENUE OF ANY SUCH PROCEEDING BROUGHT
IN SUCH COURT; AND (II) ANY CLAIM THAT SUCH PROCEEDING BROUGHT IN
SUCH COURT HAS BEEN BROUGHT IN AN INCONVENIENT FORUM.
I certify that I have read this Agreement carefully, understand that I have
given up substantial rights by signing it, and have signed it freely and without
inducement or assurance of any nature and intend it to be a complete and
unconditional release and waiver of all liability to the greatest extent allowed
by applicable law.
This Agreement contains the entire agreement between the parties hereto, and supersedes
any prior written or oral agreements between them concerning the subject matter of this
Agreement. The provisions of this Agreement may be waived, altered, amended or
repealed, in whole or in part, only upon the prior written consent of all parties hereto.
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Hang Time Hoops Basketball Camp
Fab Four Sports LLC
Name of Child: ________________________________________
Name of Parent/Guardian: ______________________________
Signature of Parent/Guardian: ___________________________
Date: ___________________
***
Through my child’s participation in Hang Time Hoops Basketball Camp, I hereby grant Fab Four
Sports LLC permission to use my child’s image and likeness in any television broadcast, photograph, video,
internet site, audio-recording, and in any and all of its publications, including website entries (collectively
“promotional materials”) without payment or any other consideration. I hereby irrevocably authorize Fab
Four Sports LLC to edit, alter, copy, exhibit, publish or distribute my child’s image or likeness for purposes
of publicizing or promoting Fab Four Sport’s programs or for any other lawful purpose. In addition, I waive
the right to inspect or approve the finished product, including written or electronic copy, wherein my
child’s likeness appears.
Initial ________________
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