Participant’s Name *

First Name

Last Name

Participant’s Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Country

(###)

###

####

*

Emregency Contact Phone #:

(###)

###

####

Please indicate your answer, by selecting YES or NO for each of the following. *

The team personnel may administer first aid until our family doctor can be contacted.

Yes

No

*

We give our consent for the team physician, trainer, and/or coaches to use their judgement in securing medical aid and ambulance service if I cannot be contacted immediately.

Yes

No

*

We give our consent for the hospital, their agents and/or licensed physician to administer emergency medical treatment as they deem necessary.

Yes

No

*

As Guardian or Legal Parent, I have read the above ASSUMPTION OF RISK section. I do waive, release and agree to the hold harmless and indemnify all the sponsors, coordination groups, volunteers, and all of its employees and members as well as officials, coaches, and officers, including Marcus Norwood. We do give our child permission to compete in the 2025 AAU Season with DTR Basketball. We acknowledge the potential for injury during athletic participation. In case of accident or injury, we are financially responsible for items such as ambulance service, doctor’s fees, hospital fees, etc. We have read, understand and discussed with our child the assumption of risk above as well as the regulations and rules of the league.

Date *

MM

DD

YYYY