Church League Basketball Adult Release Form
Name *
Your answer
Division *
I hereby state that I am covered by the following insurance policy *
Your answer
I also hereby release Church League Basketball, all coaches, and participating churches for any responsibility in the case of an accident that might occur me while participating in any League activities.
Electronic Signature *
(please type your first and last name)
Your answer
Date *
MM
/
DD
/
YYYY
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above statement. *
Required
I understand that in the event of an accident that would require emergency treatment; I give permission to the responsible coaches and or CLBBY personnel to secure medical attention for me.
Electronic Signature *
(please type your first and last name)
Your answer
Date *
MM
/
DD
/
YYYY
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above statement. *
Required
Next
Never submit passwords through Google Forms.
This form was created inside of Second Presbyterian Church. Report Abuse - Terms of Service - Additional Terms