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BALL905 Youth Foundation Player Registration & Waiver Form


Please fill in the following waiver form for BALL905 Youth Foundation. This information will be used to complete registration for your child in our programs. 


WAIVER, RELEASE & INDEMNITY-RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS, PHOTO RELEASE & INDEMNITY


I hereby agree, in return for registering as a player/participant of Ball905 Youth Foundation and a member of the Ontario Basketball Association (OBA):

TO RELEASE BALL905 YOUTH FOUNDATION AND OBA, and their respective directors, officers, employees, agents, volunteers, contractors, representatives, successors, partner clubs (collectively the “Releasees”) from any liability for any loss, damage, injury or expense (collectively “Loss”) that I may suffer as a result of my participation in and transportation to or from any Ball905 Youth Foundation Inc. program, due to any cause, including negligence or breach of contract;

TO WAIVE ANY CLAIM that I have or may have against any or all of the Releasees regarding any matter, including without limitation, any claim arising out of any Ball905 Youth Foundation and/or OBA program;

TO INDEMNIFY THE RELEASEES from any and all claims, actions or Loss resulting in any way from my participation or participation of the child named below in any Ball905 Youth Foundation and/or OBA program;

THIS DOCUMENT SHALL bind my heirs, executors, administrators, assigns and representatives and will have effect throughout my participation and membership in Ball905 Youth Foundation and OBA and, to the extent reasonably necessary to give it effect, thereafter;

THAT I am (or the child named below is) physically fit to participate in any Ball905 Youth Foundation and/or OBA programs; I am a legal guardian or custodial parent of the child named below.

THAT Ball905 Youth Foundation is authorized to take photos and videos of the child named below or me at its programs for publicity and promotional purposes only, and will own the exclusive, universal rights and royalties of said photos and videos in perpetuity.

I HAVE READ AND UNDERSTAND THIS AGREEMENT. By submitting this form, I acknowledge having read, understood and agree to the above Waiver, Release and Indemnity and further agree to conduct myself in accordance with Ball905 Youth Foundation policies, OBA policies, and Code Of Conduct.

I Agree

September 7, 2024





First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Are there any medical problems that BALL905 staff should be aware of? (Example: allergies, epilepsy, diabetes, disabilities, injuries, medications, etc.) Please specify if athlete has a life threatening allergy and if an epipen is required.
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Are there any medical problems that BALL905 staff should be aware of? (Example: allergies, epilepsy, diabetes, disabilities, injuries, medications, etc.) Please specify if athlete has a life threatening allergy and if an epipen is required.
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Are there any medical problems that BALL905 staff should be aware of? (Example: allergies, epilepsy, diabetes, disabilities, injuries, medications, etc.) Please specify if athlete has a life threatening allergy and if an epipen is required.
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Are there any medical problems that BALL905 staff should be aware of? (Example: allergies, epilepsy, diabetes, disabilities, injuries, medications, etc.) Please specify if athlete has a life threatening allergy and if an epipen is required.
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Are there any medical problems that BALL905 staff should be aware of? (Example: allergies, epilepsy, diabetes, disabilities, injuries, medications, etc.) Please specify if athlete has a life threatening allergy and if an epipen is required.
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Are there any medical problems that BALL905 staff should be aware of? (Example: allergies, epilepsy, diabetes, disabilities, injuries, medications, etc.) Please specify if athlete has a life threatening allergy and if an epipen is required.
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Are there any medical problems that BALL905 staff should be aware of? (Example: allergies, epilepsy, diabetes, disabilities, injuries, medications, etc.) Please specify if athlete has a life threatening allergy and if an epipen is required.
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Are there any medical problems that BALL905 staff should be aware of? (Example: allergies, epilepsy, diabetes, disabilities, injuries, medications, etc.) Please specify if athlete has a life threatening allergy and if an epipen is required.
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Are there any medical problems that BALL905 staff should be aware of? (Example: allergies, epilepsy, diabetes, disabilities, injuries, medications, etc.) Please specify if athlete has a life threatening allergy and if an epipen is required.
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Are there any medical problems that BALL905 staff should be aware of? (Example: allergies, epilepsy, diabetes, disabilities, injuries, medications, etc.) Please specify if athlete has a life threatening allergy and if an epipen is required.
Parent or Guardian's Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Are there any medical problems that BALL905 staff should be aware of? (Example: allergies, epilepsy, diabetes, disabilities, injuries, medications, etc.) Please specify if athlete has a life threatening allergy and if an epipen is required.
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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