Saint Cecilia CYO Basketball 2019-2020

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Saint Cecilia CYO Registration 2019

PLAYER INFORMATION

* Last Name:

* First Name:

* Gender:

* Current Grade:

* Current Age:

* Street:

* City:

State:

Zip Code:

* Birthdate:

PARENT/GUARDIAN #1

* First Name:

* Last Name:

* E-Mail:

* Cell Phone:

Home Phone:

Address (if different from player address):

Coaching Interest? Y/N:

PARENT/GUARDIAN #2

First Name:

Last Name:

E-mail:

Cell Phone:

Home Phone:

Coaching Interest? Y/N:

Address (if different from player address):

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

Relationship to Player:

* Primary Care Physician (PCP):

* PCP Contact Info (Phone):

WAIVER INFORMATION

ST. CECILIA PARISH – WESTERN MASSACHUSETTS
CATHOLIC YOUTH ORGANIZATION (CYO) BASKETBALL PROGRAM

Parent/Guardian Permission and Acknowledgement of Conditions for
Participation in the Saint Cecilia Parish and Western Mass CYO Basketball Program

1. I, the parent or authorized guardian of the child named above, give permission for his/her participation in the St. Cecilia Parish and Western Massachusetts CYO basketball programs and all related activities, including but not limited to transportation to and from games or practice sessions.

2. I agree to direct my child to cooperate and comply with reasonable directions and instructions from the St. Cecilia Parish CYO basketball adult volunteer leaders (coordinator and coaches).

3. I agree to be responsible for all medical expenses relating to injury of my/our child as a result of his/her participation in any CYO basketball activity, whether or not caused by the negligence of St. Cecilia Parish or Western Massachusetts officers, employees, agents or volunteers or other participants.

4. I understand that children competing in athletic and recreational sports programs risk injury to the body, psyche or property damage to themselves and others. Such injuries can be caused by teammates, other persons or accidentally or intentionally self-inflicted, faulty equipment or facilities, conditions of recreational facilities or the schools or parishes where sports activities are held, vehicle accidents while in transport or through the activity itself. Protective equipment used in a sports activity is not a safeguard against injury.

RELEASE AND WAIVER OF LIABILITY AGREEMENT
In consideration for being permitted to participate in CYO basketball activities, use the equipment provided and to enter the premises or facilities of St. Cecilia Parish or Western Massachusetts CYO, or other game or practice facilities, for any purpose including observation and participation in activities, the parent or guardian for him or herself and any successors in interest and on behalf of the minor child agrees:

1. To release, waive, discharge and promise not to sue St. Cecilia Parish or the Western Massachusetts CYO and its affiliated entities, its officers, directors, employees, agents and volunteers from all liability for any loss or damage, and any claim or demands therefore on account of serious or mortal injury to the body, injury to psyche or property of the minor child, or undersigned parent or guardian, whether caused by negligence or other conduct by the officers, directors, employees, agents and volunteers while the minor child, parent or guardian is participating in CYO basketball activities or in, upon or about the premises of St. Cecilia Parish and Western Massachusetts CYO or any of its facilities or equipment.

2. To hold harmless St. Cecilia Parish and Western Massachusetts CYO and its affiliated entities, its officers, directors, employees, agents and volunteers from any loss, liability, damage or cost it may incur due to the presence of the minor child, parent or guardian in, upon or about the premises of St. Cecilia Parish and Western Massachusetts CYO, its facilities or equipment, or while participating in CYO basketball activities whether caused by the negligence of officers, directors, employees, agents and volunteers or otherwise.

3. That the parent or guardian, having read this Agreement, voluntarily signs the Agreement and that no oral representations, statements or inducements apart from the contents of this written Agreement have been made.
I have read this Agreement and understand everything written above.

I/we agree with the above *

* indicates required fields

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Saint Cecilia CYO Registration 2019