Black Hills State University Basketball Camp for Boys and Girls June 24th
Camp Times:

3rd-6th grade boys and girls: 10 AM-12 PM mountain time
7th-12th grade boys and girls: 1 PM-3 PM mountain time

Where: Cody-Kilgore High School Gym

Cost: $40
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Parent/Guardian Name
Grade entering fall 2024:
Parent/Guardian Phone Number
Student Name
School you currently attend.

PARENTS OR GUARDIANS AGREEMENT OF WAIVER OF LIABILITY,

INDEMNIFICATION AND MEDICAL RELEASE

(For use by adults during special events and activities if the participant is under 18 years of age.)

 

Said undersigned parent and natural guardian or legal guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees on behalf of the participant and his/her executors, administrators, heirs, next of kin, successors, and assigns, to:

 

a. waive, release and discharge from any and all liability for participant's death, disability, personal injury, property damage, property theft or actions of any kind which may hereafter accrue to participant and his/her estate, the State of South Dakota, and its officers, agents and employees; and

 

b. indemnify and hold harmless the Cody Kilgore Unified Schools from and against any and all liabilities and claims made by other individuals or entities as a result of participant's participation or actions during this activity or event.

 

The undersigned further consents to and authorizes medical treatment to the participant, which may be deemed advisable in the event of injury, accident or illness during this activity or event.

 

This release and waiver shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

 

I, the undersigned, acknowledge that I have read and understand the above Release.


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