2017 Medical/Liability Release Form

 

I hereby authorize the staff of the Team Ichiban Basketball Club to act for me, according to their best judgment, in any emergency requiring medical attention, and hereby waive and release the Club or its teachers/directors or anyone associated with the Team Ichiban Basketball Club from any liability for any injuries or illnesses incurred while at any Club functions.

I have no knowledge of any medical problem or physical impairment that would be affected by participation.  The Team Ichiban Basketball Club staff/or the nearest medical facility is hereby authorized to render primary care.

Assumption of Risk/Release from Liability

It is further understood that Team Ichiban Basketball Club does not provide medical insurance covering injuries of any nature incurred at any Team Ichiban Basketball Club function.  The undersigned hereby releases Team Ichiban Basketball Club, its successors, assigns, officers, agents, and employees, from any and all claims, demands, and causes of action whatsoever in any way growing out of or resulting from participation in Team Ichiban Basketball Club functions.

 

Participant’s Name:____________________________________________

 

Participant’s Signature:_________________________________________

 

Participant’s Parents/Guardian’s

Signature:____________________________________________________