ROUGE VALLEY SPORTS & REC
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Last Name *
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Parent Name *
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Emergency Contact (when the parent cannot be reached) (Name / Phone number) *
Consent *
I acknowledge that this athletic event is a test of a person’s physical and mental limits and carries with it the potential for injury or hurt. I hereby assume all of the risks of participating in this event. I certify that I am physically fit and have not been advised otherwise by a qualified medical person not to participate in sporting activities. In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, release, and discharge from any and all liability from this event, Coach John Leadership & Community Engagement Initiative , West Rouge Basketball, employees and volunteers, (B) indemnify and hold harmless all entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of my actions during this event. I understand that at this event or related activities I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, sponsors, affiliate or organizers. This AWRL shall be construed broadly to provide a release and waiver to the maximum extent permissible under the applicable law. I hereby certify that I have read this document and I understand its content. (Signature: type your name)
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