| Participants name: ___________________________ |
(Boy) (Girl) | Birth Date:_________Age:_________ |
| Address: | City | State________Zip______ |
| Home Phone# | Cell Phone# | E-mail Address |
| Name of Parent or Guardian ___________________________ |
School | Present Grade |
| Name of Current Basketball Coach: | Head or Assistant ___________________________ |
Name of Current Team ___________________________ |
| School District you live in: | (Iowa City) (Coralville) (Cedar Rapids) (West Liberty) (Rockford) (Quad Cities) |
Other |
Please fill out the waiver below. The waiver and liability MUST BE SIGNED to have a valid registration.Waiver of Liability and PromotionVenom Sports-personal basketball training/skills program (hereinafter referred to as "Venom Sports") is not obligated to furnish any insurance. I, the parent or guardian of the applicant agree that "Venom Sports" and all individuals participating in the "Venom Sports" Basketball Program in any capacity, will not be liable for any causes of actions, claims and injuries arising out of the participation of the applicant in the "Venom Sports" Basketball Program, and hereby release all said individuals from such claims and liabilities. The undersigned ackknowledges that in all sports there are certain risks of physical injuries and all players participate at their own risk, I, as legal guardian or parent of any applicant hereby consent to the participation of the applicant in the "Venom Sports" Basketball Program under the above mentioned conditions. I, also agree to abide by the young athlete's bill of rights. I, as the parent or legal guardian, state that the child________________________________is in ample sports condition to participate in the "Venom Sports" training program. By signing this form, you exclude Acie Earl and any members of his staff from any normal injury and liability that might occur or labeled as normal sports injuries. If you do not wish to give consent for your player to be photographed, videotaped and/or filmed while participating in any "Venom Sports" activity and for the resulting photos, etc. to be used by "Venom Sports" for educational and promotional purposes please check the space below. I have read and understand the above: |