Woodbury Heights Athletic Association

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WHAA Basketball Clinic - Youth Volunteer release form

* Sport:

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Home or Cell Phone:

* Email:

* Birthdate:

Uniform Pants/Shorts Size:

* Grade:

* Gender:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

EMail:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

WAIVER INFORMATION

Waiver and Indemnification:
I grant the Woodbury Heights Athletic Association and the assigned coaches and assistant coaches the authority to have my son/daughter transported and treated in case of any medical emergency, in my absence. I recognize that the insurance policies carried by the Woodbury Heights Athletic Association and the respective sport association/league are policies designed to cover my insurance company deductibles and/or any medical treatment not covered by my insurance company. I recognize that my insurance company will act as the primary carrier and all other non-insured expenses may be submitted to the respective sport association/league for review and possible reimbursement. I also give my consent for my child to participate in the Woodbury Heights Athletic Association sports program. I hereby agree to indemnify, defend and hold harmless, and release the Woodbury Heights Athletic Association, its board of directors, coaches, assistant coaches, volunteers and trainers, from all claims, liability and damages for injuries received by my child during, or resulting from, participation in this program. This includes, but is not limited to, practice sessions and games. I agree to pay all reasonable attorneys' fees incurred by all of the foregoing indemnitees in order to enforce this provision. I also attest that my child has had a recent examination by a licensed doctor who has certified that my child can participate in strenuous physical activity.

Child Photo Waiver:
I authorize the Woodbury Heights Athletic Association to use my child’s name, picture or team photo in newspaper articles, on the Woodbury Heights Athletic Association Website, or on the Woodbury Heights Athletic Association Facebook page.

Code of Conduct:
I acknowledge that I have reviewed, or are familiar with Woodbury Heights Ordinance 3-2002 (Youth Sports Code Of Conduct) and agree that I, as well as all my family and any guests I invite, will abide by the rules and conditions set forth within this ordinance. A copy of the ordinance can be found on both our website (www.whaasports.org) and the Woodbury Heights Borough website (http://bwhnj.com/borough-ordinance.html).

I/we agree with the above *

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WHAA Basketball Clinic - Youth Volunteer release form