I hereby allow my son/daughter/ward _____________________, for whom I am the legal guardian, to participate in the Premier Hoops (PH) Training Program. I hereby agree to indemnify and hold harmless PH, The JCC of the North Shore in Marblehead, MA, The YMCA of the North Shore in Beverly, MA, Bishop Fenwick High School, Watertown Youth Basketball Association, Latitude Sports Clubs and their employees and agents from and against all claims, losses, or liability, including injury associated with his/her participation as a client. I also understand that it is Premier Hoops mission to provide personal training and guidance to each athlete and they will accomplish this mission through weight training, basketball skill workouts, and cardiovascular workouts.
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Print Name of Youth
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Signature of Parent/Guardian
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Date
(H)Phone:_______________(W)Phone:_______________(C)Phone:________________
TRANSPORTATION RELEASE
______________________ may be accompanied and transported by _______________________; however, neither PH and its employees and agents assume any liability by such accompaniment or transportation or for any injuries or damages that occur while traveling to or from the venue or during the time in attendance at or participating in the activity. I DO / DO NOT (circle desired response) grant permission to PH employees/trainers to transport my child/ward to/from activities located away from the regular meeting site.
Please initial one:
____ I understand that _____________________ will transport my child and serve as their chaperone.
____ I give my child permission to drive themselves to the activity
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Signature of Parent/Guardian
_________________________
Date
Parental/Guardian Consent Form & Liability Waiver (Page 2)
MEDICAL WAIVER
In the event of an emergency, I DO / DO NOT (circle desired response) grant permission to PH to transport my child/ward to a hospital/after hours clinic for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. As the parent/legal guardian, I give full authorization to PH trainers to secure medical care or treatment for above named youth. This treatment may include assistance from the nearest physician, medical clinic, hospital, trained nurse or EMT in the event of illness or injury that requires immediate attention, as determined by the trainer. In the event that I cannot be contacted, and an emergency has occurred, I give permission to the treating medical institution and/or medical providers to hospitalize and administer the appropriate treatment deemed medically necessary. I further agree that PH, and its employees and agents will not held responsible for injuries or damages arising from the provision of any such emergency medical treatment. I understand that as a parent/legal guardian, I will be responsible for the cost of any service or treatment provided. This authorization shall remain effective until he/she is no longer a client of Premier Hoops.
I have read this document, I understand its contents, and I agree to its terms. Please list any limits to medical treatment: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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Signature of Parent/Guardian
_____________________
Date
MEDIA RELEASE
I understand that my child’s image may be captured on video and/or photographed during events, whether by Premier Hoops or by media organizations that may cover the event. I give permission for my child to participate and be videotaped and photographed. I also understand that no compensation is provided for any appearance or statements recorded by Premier Hoops or any media in attendance at the event.
Parent/Guardian Signature: __________________________________
Date: _______________