Fellowship Bible Church CCU Basketball
Liability/Waiver/Registration Form for FBC and Chinese Christian Union (CCU) Basketball

All practices held at Mid-Peninsula Boys' and Girls' Club, 200 North Quebec, San Mateo on Saturday evenings. Actual time and location may be different for each team. Practices will begin in mid April.

Please turn in completed waiver form and registration OR complete online registration by Sunday, March 24. Return check to Fellowship Bible Church (Separate $190 fee and $25 jersey deposit checks made out to Fellowship Bible Church). Registration is complete and roster spot secure when registration, waiver and fees are submitted. Rosters are limited to 11–12 spots per team, a waiting list will start after teams are full.

For more information:
Contact at Pastor Kevin 650.591.1322 or kkan@fbc-belmont.org (cc: Barry Pon at bpon45@gmail.com)
Fellowship Bible Church: 2710 Ralston Ave, Belmont, CA 94002
http://www.fbc-belmont.org/sports.html

Email address *
Participant's Name (First Last) *
Your answer
I would like to sign up for (grade presently in) *
Skill / Experience Level for Age/Team Level *
Address *
Your answer
Age (as of June 2019) *
Your answer
Gender *
Current Grade (in Spring 2019) *
Birthday *
Your answer
Uniform/T-Shirt Size *
Player Email Address *
Your answer
Parents' Name (if under 18) *
Your answer
Parent Email Address (if under 18) *
Your answer
Parent Cell Phone # (if player is under 18) *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Relationship *
Your answer
Emergency Contact Address *
Your answer
Emergency Contact Mobile # *
Your answer
Health Insurance Provider Company Name *
Your answer
Health Insurance Policy Number *
Your answer
All coaches, assistants, referees, and scorekeepers are volunteers. We would love for you to join us and help make the league fun and memorable for all participants. If you can help in one or more of the following areas, please let us know. Please check one or more of the following:
Assumption of Risk, Waiver, and Release from Liability
Fellowship Bible Church Sport Program Assumption of Risk, Waiver, and Release from Liability:
I, (or my child) desires to participate in Fellowship Bible Church Sports Program. This Assumption of Risk, Waiver, and Release from Liability covers the entirety of my participation in the FBC Sports Program, including travel to any locations off of the Fellowship Bible Church campus in order to participate in activities associated with the FBC Sports Program.

Risk Factors- I understand and acknowledge that the use of equipment and facilities provided by Fellowship Bible Church and participation in the FBC Sports Program involves risks including, but not limited to the following: risk of property damage, bodily injury, including, but not limited to permanent disability, paralysis, and possibly death. These risks may result from a variety of circumstances including, but not limited to, the use or misuse of the equipment or facilities, from the activity itself, from the acts of myself or others, including Fellowship Bible Church and its agents or from the unavailability of emergency medical care.

Assumption of Risk- my participating (or my child's participation) in the FBC Sports Program at my (or his or her own free will). I understand that my decision to participate or allow my child to participate in the FBC Sports Program is entirely voluntary. I assume full responsibility for all risks that may arise out of or result from my child's participation in the FBC Sports Program, including but not limited to those risks described above.

Acknowledgement of Policies and Procedures- I acknowledge that I have read, know, and agree to all of the policies and procedures relating to my participation or my child's in the FBC Sports Program. I understand that the safe and proper use of all facilities, equipment or participation in the activity is dependent upon carefully following these policies and procedures. I agree and my child agrees to comply with and abide by all rules, regulations and policies of the Boys and Girls Club of San Mateo (or other facility used) and of Fellowship Bible Church. I understand that Fellowship Bible Church reserves the right to revoke or terminate my child's participation in the FBC Sports Program for any violations of these rules, regulations, or policies.

Release, Indemnify, and Defend. I hereby release, waive, discharge, and hold harmless Fellowship Bible Church, and all of their affiliates, predecessors, successors, trustees, officers, directors, faculty, employees, agents and representatives, past or present (hereinafter jointly referred to as “the Released Parties") from any and all claims, suits, liabilities, judgments, costs and expenses ("Claims") for any property damage, property loss or theft, personal injury or illness, death or other loss arising from or relating to my participation in the FBC Sports Program. I also agree to defend, indemnify and hold harmless the Released Parties from and against any Claims arising from or related to my own or my child's or my own acts or omissions in connection with my participation in the FBC Sports Program.

Prerequisite Skills. I acknowledge that I have or my child has the requisite skills, qualifications, physical ability and training necessary to properly and safely participate in the FBC Sport Program. I agree that if I have any questions as to what skills, qualifications, or training is necessary to properly participate in the FBC Sports Program, then I shall direct such questions to the appropriate individuals.

Waiver- I hereby waive any protections afforded by any statute or law in any jurisdiction whose purpose, substance and/or effect is to provide that a general release shall not extend to claims, material or otherwise which the person giving the release does not know or suspect to exist at the time of executing the release. This means, in part, that I am releasing unknown future claims.

Payment for Damages. I agree to pay for any and all damages to any property or Release Party caused by me negligently, willfully or otherwise.

Representatives. I enter into this agreement for myself or child, as well as for my heirs, assigns and legal representatives.

Consent for Emergency Treatment- I consent to medical treatment for me or my child for emergencies that occur during or are related to my participation in the FBC Sports Program where I am unable to consent to such treatment. I understand the provisions of this Assumption of Risk, Waiver, and Release from Liability apply to any treatment that might be provided to me under this Section, including but not limited to Section 1, Section 2, and Section 4.

Insurance- I understand that I am solely responsible for any medical, health or personal injury costs relating to my my participation or my child's participation in the FBC Sports Program. I understand that I am strongly encouraged to have a medical physical examination for me or my child and purchase health insurance prior to any and all participation in the FBC Sports Program.

Jurisdiction. This Assumption of Risk, Waiver, and Release from Liability shall be governed in all respects by the laws of the State of California. The parties agree to use the State of California for Jurisdiction and the County of San Mateo as Venue for any disputes between the parties related to this Assumption of Risk, Waiver, and Release from Liability.Severability. If any term or provision of this Assumption of Risk, Waiver, and Release from Liability is held to be illegal, invalid or unenforceable, or the application thereof to any person or circumstance shall to any extent be illegal, invalid or unenforceable under present or future laws effective during the term hereof or of any provisions hereof which survive termination, then and in any such event, it is the express intention of the parties that the remainder of this Assumption of Risk, Waiver, and Release from Liability, or the application of such term, clause or provision other than to those as to which it is held illegal, invalid or unenforceable, shall not be affected thereby, and each term, clause or provision of this Assumption of Risk, Waiver, and Release from Liability and the application thereof shall be legal, valid and enforceable to the fullest extent permitted by law. I have read and fully understand this Assumption of Risk, Waiver, and Release from Liability and understand that it relates to surrendering and releasing valuable legal rights. I do so freely and voluntarily.

I am the participant or the parent or legal guardian of the above named minor. I have read and understand this Assumption of Risk, Waiver, and Release from Liability in its entirety and understand that it relates to surrendering valuable legal rights of the minor and myself. I agree to be bound by all the terms of the Assumption of Risk, Waiver, and Release from Liability. I also give my consent to the participation in the activity of the minor. If you agree and give consent, please Initial below: *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service