Lower Dauphin Youth Basketball Association

I realize that injuries can be a consequence of participating in this basketball program and no amount of reasonable supervision or use of the facilities will prevent injury. I fully understand the nature of the risk involved and I voluntarily assume on behalf of my child, myself and my family all risk of possible harm or injury in participating in this basketball program. I have carefully considered how the possible consequences of injury may impact my child, myself and my family and I choose to accept this risk and allow my child to participate in the basketball program.

In accepting this risk, I expressly and explicitly release, discharge and waive any and all responsibility of the LDYBA, Lower Dauphin School District, Coaches, Parents, Officials, and all staff in regard to any injuries to my child as of a result of my child's, myself and my family participation in this basketball program.

By my signature below or by checking the box, I certify that I completely understand this document. I certify that I am eighteen years of age or older, and I am not under the influence of any drugs or alcohol.