IMPACT ATHLETICS

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Impact Athletics Moco Summer Jamfest Team Registration

Team Information

* Team Name:

* Head Coach:

Home Phone:

Email:

Gender:

Division....(6th,7th.8th.9th):

Asst. Coach

Firstname:

Lastname:

EMail:

Home Phone:

Cell Phone:

Emergency Contact:

Phone:

Relationship to Team:

WAIVER INFORMATION

Waiver of Liability, Assumption of Risk and Indemnity Agreement for Impact Athletics Summer Jamfest Basketball Tournament
With a full understanding of the potential risks, I hereby assume the risks of participating in a basketball
contest event. I acknowledge that my participation in the Impact Athletics Summer Jamfest. Basketball Tournament is voluntary
and carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid
injuries. The specific risks vary from one activity to another. Risks range from: minor injuries such as
scratches, bruises, and sprains to major injuries such as eye injuries, back injuries, broken bones or
concussions, to catastrophic injuries including paralysis and death.
On behalf of myself, my executors, administrators, heirs, next of kin, successors and assigns, I hereby waive,
release and forever discharge Impact Athletics, its members, directors, officers,
sponsors, volunteers or representatives of any of the foregoing: from any and all claims or liabilities for death,
personal injury or damage of any kind or nature whatsoever which arise out of or related to my participation
in the Impact Athletics Moco Summer Jamfest Basketball Tournament.
As evidence of my signature, I certify that I have read and understand the foregoing waiver and release of
liability, that I understand that I am giving up substantial rights by signing this waiver and release of liability,
that I intend to be bound by the terms of the foregoing waiver and release of liability, and that I am voluntarily
signing the said waiver so that I can participate in the Impact Athletics Moco Summer Jamfest Basketball Tournament.

I/we agree with the above *

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Impact Athletics Moco Summer Jamfest Team Registration