Next Level Pro Am Basketball Association - (Chicago, IL)

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NLPABA PLAYER DRAFT REGISTRATION FORM

PLAYER INFORMATION

First Name:

Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Birthdate:

Email:

COLLEGE OR PROFESSIONAL:

* Team Name:

UNIFORM NUMBER:

* Height:

Position:

CENTRAL, NORTH, SOUTH:

Work Phone:

Email:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

I, the undersigned, player, acknowledge, agree and understand that:

• I understand that there are certain risks of damages and injuries, including death, inherent in the practice and play of basketball, as well as in traveling in other related activities incidental to me, and I am willing to assume these risks. These risks include but are not limited to those hazards associated with weather conditions, travel, playing conditions, equipment and other participants.

• I understand that the very nature of the game of basketball is hazardous and risky, including but not limited to, the acts of running, jumping, stretching, sliding, diving, and collisions with other players and with stationary objects, all of which can cause serious injury or death to me and to other players.

• I certify that I am physically fit, have sufficiently trained for participation in this event, and have not been advised otherwise by a qualified medical person.

• Further, I agree that in consideration for the right to allow me as a member of the team designated below and in consideration for permission to play at the sites arranged for by the team and/or league

1. I do voluntarily elect to accept and solely assume all risks of injury incurred or suffered (a) while practicing or playing as a member of the team so designated, (b) while serving in a non-playing capacity as a team member or observer during practice or play by other teams or by other players on my team, and (c) while on or upon the premises of any and all of the fields arranged for by my team or league for practice or play.

2. In addition to giving my full consent for participation, I do hereby waive, release, discharge and agree not to sue the team and league designated below, the owner or operator of any sites or other entity designated below, Next Level Pro Am Basketball Association, Next Level Officiating, its Parks and Recreation Department and elected officials, board members, employees and volunteers or any person or entity connected with the team, league for any claim, damages, costs including attorneys fees, or cause of action which I may have in the future as a result of damages, injuries, including death, sustained or incurred by my participation from whatever cause including but not limited to the negligence, breach of contract or wrongful conduct of the parties hereby released.

• I hereby certify that I am fully capable of participating in the designated sport and that I am healthy and have no physical or mental disabilities or infirmities that would restrict full participation in these activities.

• I further agree on behalf of myself listed below, that I shall hold harmless and fully indemnify the parties hereby released from any and all claims, damages, costs including attorney fees, and causes of action which may arise from any cause of action made by me , even if the damages, injuries or death are caused in whole or in part by any of the persons or entities hereby released.

WAIVER INFORMATION

I/we agree with the above *

Player Fees:

Signature:

Date:

* indicates required fields