76ers Participation Waiver
THIS FORM MUST BE FULLY BE SIGNED AND SUBMITTED BEFORE YOU ARE
ALLOWED TO PARTICIPATE.

I wish for my child to participate in the 76ers program and services. I hereby agree as follows:I understand that 76ers is operated as an individual enterprise and involves competition and sometimes physical contact with and against other participants and that there are inherent dangers and risk of injury involved with such activities. The dangers, hazards and risks may arise from my Child’s own actions, in actions, or negligence as well as from the actions, in actions or negligence of others, or the condition of the premises. I also acknowledge and understand that there may be other dangers, hazards or risks not presently known or reasonably foreseeable. Participation in 76ers includes travel to and from training premises and therefore, I, for myself and on behalf of my child, voluntarily accept and assume all risk of injury, loss of life or damage to property arising out of training, preparing, participating and traveling to or from 76ers. I hereby release 76ers, its administration, faculty, staff, student Leaders,and all other officers, directors, employees and agents and the entity known as 76ers, along with its coaches, employees, volunteers and agents from any and all liability as to any right of action that may accrue to me, or my Child’s participation.I furthermore release, identify and hold harmless 76ers from and against any and all liability, actions, debts, claims and demands of every kind whatsoever,specifically including, but not limited to, any claim for negligence or negligent acts or omissions and any present or future claim, loss or liability for injury to person or property that I or my Child may suffer, for which I or my Child may be liable to any other person, that may or does arise out of my Child’s participation in 76ers. In the event of an accident or serious illness, I hereby authorize representatives of 76ers to obtain medical treatment for my Child. I hereby hold harmless and agree to identify 76ers from any claims, causes of action, damages and/or liabilities, arising out of or resulting from said medical treatment. I further agree to accept full responsibility for any and all expenses, including medical expenses that may derive from any injuries that may occur to my Child during his participation in 76ers. This RELEASE shall be governed by and construed under the laws of Michigan. I agree that any legal action or proceeding relating to this RELEASE, or arising out of any injury, death, damage or loss as a result of my participation in any part of 76ers, shall be brought only in Washtenaw County, Michigan.
Parent Signature - Type Name
Child's Name
Date of Birth
MM
/
DD
/
YYYY
Parent's Email
Emergency Contact Name
Emergency Contact Phone Number
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