Contact Name *

First Name

Last Name

Contact Number

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Participant Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Program

Junior Girl's Hoops - Wednesdays - Grade 1-3

3x3 League - Wednesdays - Grade 4-6

Skills + Gameplay - Tuesday/Thursday - Grades 7+

Informed Consent Agreement *

I/We the UNDERSIGNED hereby acknowledge that RISKS OF INJURY are inherent to participation in sports and recreation activities. These types of injuries may be minor or serious and may result from one’s actions, or the actions or inactions of others, or a combination of both. I/We understand that the RULES and REGULATIONS are designed for the safety and protection of the participants and hereby undertake to abide by these rules and regulations. I/We hereby WARRANT being physically fit to participate and understand the CHOICE to participate brings with it the ASSUMPTION OF THOSE RISKS AND RESULTS which are part of these activities. I/We agree that VAUGHAN CITY BASKETBALL shall not be liable for any injury to my/my child’s person and loss or damage to my child’s personal property arising from, or in any way resulting from, my/my child’s participation in these activities. UNLESS such injury, loss or damage is caused by the SOLE NEGLIGENCE of VAUGHAN CITY BASKETBALL or its employees are agents while acting within the scope of their duties.

I/We declare having read and understood the above INFORMED CONSENT AGREEMENT in its entirety and hereby consent to participate acknowledging all the foregoing.

Media Release *

I/We give permission for use of any photos or videos taken of myself/my child to appear in any media, promotional materials or advertisements produced by VAUGHAN CITY BASKETBALL.