GCT TRAINING - NEW VISIONS BASKETBALL ASSOCIATION - (Sicklerville, NJ)

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Youth COMMUNITY service Volunteers

STUDENT/ VOLUNTEER INFORMATION

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* Birthdate:

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PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* EMail:

Cell/Home Phone:

Work Phone:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

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MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to volunteer:

Insurance Carrier:

Policy #:

WAIVER INFORMATION

I hereby give my consent by checking below for my child(ren) to participate in the 2017 season of New Visions Basketball (NVBA) summer program. In signing this form, I affirm that I am unaware of any medical or other reason(s) my child(ren) should not participate in this program. I also affirm that my questions regarding this program have been answered to my satisfaction. In consideration for being allowed to participate in this program. I agree to assume the risk of such program, and further agree to hold harmless NVBA and its staff members conducting the program, from any claims, suits, losses or related causes for such action for damages, including but not limited to such claims that may result from injury or death, accidental or otherwise, during or arising in any way from the program.

By participating in the program, I grant NVBA an limited license to use my athlete(s) name,likeness,image,voice, athletic performance, biographical and other information,in any format whatsoever,and to distribute, broadcast and exhibit these without charge , restriction or liability, but only for the purposes of advertising or promoting the sport of athletics. In no event, however, will such usage constitute an endorsement of any product or service without my specific written consent.

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GCT TRAINING - NEW VISIONS BASKETBALL ASSOCIATION

Youth COMMUNITY service Volunteers