Church League Basketball Youth Release Form
Player Name *
Your answer
Grade (as of 2018-19 school year) *
I/We hereby state that our daughter/son (player listed above) is covered by the following insurance policy: *
Your answer
I/We also hereby release Church League Basketball for Youth, all coaches, and participating churches for any responsibility in the case of an accident that might occur to my/our daughter/son 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/We understand that in the event of an accident that would require emergency treatment; that every effort will be made to reach me/us. If I/we cannot be reached, I/we give permission to the responsible coaches and or CLBBY personnel to secure medical attention for my/our daughter/son.
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
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