I-270 Clarksburg Basketball (CYO)

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Cedar Grove Elementary Basketball Class

* First Name:

* Last Name:

* Street:

* City:

* State:

Zip Code:

Home Phone:

Gender:

Parent Firstname:

* Parent Lastname:

* EMail:

Home Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

WAIVER INFORMATION

Clarksburg Young Organization (CYO) and any facilities where tryouts, practices, or games will be played will assume no liability for injury or damages arising from the results of the above named Athlete’s participation unless due to the willful misconduct or gross negligence on the part of CYO, its affiliates, or agents. Due to the strenuous nature
of basketball, the Athlete participating and their parents are urged to consult their physician concerning the Athlete’s fitness to participate. Basketball presents certain inherent risks and hazards, which the participating Athlete is urged to consider and which the Athlete assumes the outcomes of such risks and hazards. I hereby approve of the participation of my child, the above named Athlete, in the CYO tryout program
and consent to the emergency medical treatment for my child on my behalf. To the best of my knowledge, there are no physical or other conditions which will interfere with my child’s participation.

I/we agree with the above *

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Cedar Grove Elementary Basketball Class