Player Name *

First Name

Last Name

Player Phone

(###)

###

####

Parent Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Address *

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Liability Waiver *

Acknowledgment of Risk and Waiver of Liability I, the undersigned, as the parent or legal guardian of the above-named athlete, do hereby grant permission for my child to participate in the basketball tryouts, practices, games, and related activities (hereinafter “Activities”) organized by Dunwoody United Basketball at the MJCCA. I understand and acknowledge that participation in basketball activities involves inherent risks, including, but not limited to, the risk of physical injury, illness, or damage to personal property. I further acknowledge that Dunwoody United Basketball and the MJCCA are not responsible for the provision of medical or health insurance coverage for my child. Release and Waiver of Liability In consideration for my child being allowed to participate in the Activities, I, on behalf of myself, my child, and our respective heirs, executors, administrators, and assigns, hereby release, discharge, and hold harmless Dunwoody United Basketball, the MJCCA, its employees, coaches, volunteers, and agents (collectively referred to as “Released Parties”) from any and all claims, liabilities, damages, or causes of action arising out of or in connection with my child’s participation in the Activities, including but not limited to, injury, illness, or damages sustained during tryouts, practices, or games, whether arising from negligence or otherwise. Medical Consent I further authorize the staff of Dunwoody United Basketball and the MJCCA to act in their best judgment in the event of a medical emergency involving my child, and I agree to assume full financial responsibility for any medical treatment provided. Agreement to Terms

I have carefully read and fully understand this Liability Waiver and Release Agreement. I voluntarily agree to its terms, and I acknowledge that this document is binding upon me and my child.