Forms 
      Pflugerville Youth Basketball Association
       
      Approval To Participate, Consent For Medical Treatment and Waiver And 
      Release
       
      Players Last Name: ______________First Name:______________Birthdate:____________
       
      Approval to Participate
      I/we, the parent/legal guardian(s) of the above-named player, a minor, or, 
      as a player over the age of 18, hereby give my/our permission and consent 
      for said player to participate in any and all activities of the 
      Pflugerville Youth Basketball Association and its affiliated organizations 
      (hereinafter collectively “PYBA”), including transportation to and from 
      such activities.
      Waiver of Liability and Assumption of Risk
      I/we understand and acknowledge that PYBA activities are inherently risky 
      and may result in serious injury, or even death. I/we, for 
      myself/ourselves and the player and our respective heirs, administrators 
      and successors, intending to be legally bound, hereby (i) expressly assume 
      any and all risks and hazards directly or indirectly incidental to such 
      participation in PYBA activities, including transportation to and from 
      such activities; (ii) expressly waive, release, indemnify and agree to 
      hold harmless, defend and indemnify PYBA, the owners and operators of the 
      facilities used for the Programs and all its directors, officers, 
      employees, agents, sponsoring organizations, sponsors, organizers, 
      administrators, participants, coaches, assistants, or other 
      representatives, including any and all persons or groups providing 
      transportation to and/or from any PYBA activities, from and against any 
      and all claims, demands, or lawsuits directly or indirectly arising from 
      participation in any PYBA activities.
      I/we, the parent(s)/legal guardian(s) of the above-named player, a minor, 
      or as a player over the age of 18, agree that I/we and the player will 
      abide by the rules and regulations of the PYBA.
      I/we understand that participation in PYBA involves a significant 
      commitment of time and effort and hereby pledge our family’s best effort 
      to satisfy this commitment.
      I/we hereby waive any and all rights to any photographs, video tapes, 
      motion pictures, recordings, or any other record of the activities which 
      may be made by the PYBA and affiliate organizations.
      I/we further agree to indemnify the PISD, Immanuel Lutheran Church and/or 
      PYBA for damages caused by my/our child to the PISD, Immanuel Lutheran 
      Church and/or PYBA facilities or equipment.
      Consent to Medical Treatment
      I/we authorize PYBA or their representatives, as agent to the undersigned, 
      to give consent for emergency medical care prescribed and deemed advisable 
      by a duly licensed Doctor of Medicine or Doctor of Dentistry or Emergency 
      Medical Technician. This care may be given under whatever conditions are 
      necessary to preserve the life, limb or well being of myself or my 
      dependent player, as appropriate. This authorization is given in advance 
      of any specific diagnosis, treatment or hospital care being required, but 
      is given to provide authority and power on the part of my agent to give 
      specific consent to any and all diagnosis, treatment or hospital care 
      which the physician in the exercise of his best judgment may deem 
      advisable. This authorization will be applied to emergency care only, and 
      shall remain effective until revoked in writing.
      It is my/our intent that this "Approval To Participate, Consent For 
      Medical Treatment and Waiver And Release" remain in full force and effect 
      at all times. I/we may cite and incorporate this document by reference in 
      all future registration forms that I/we may submit for my/our child's 
      participation in PYBA activities, particularly those we may submit 
      electronically.
       
      Primary Parent/Guardian Signature: Date: _______________________________
       
      Primary Parent/Guardian Name ___________________________________________
       
      Secondary Parent/Guardian Signature: Date: _____________________________
       
      Secondary Parent/Guardian Name _________________________________________