Spencer Basketball Fall 3 on 3 League
  • Dates: Sunday, October 8th, 15th, 22nd, and 29th
  • Location: Spencer High School
  • Times: 5th & 6th Grades  3:00 - 4:00 / 7th & 8th Grades  4:00 - 5:00
  • Cost: $40 - Checks payable to Spencer Youth Basketball Association
  • Open to Boys and Girls
Email *
Player Name *
Grade *
Team *
Parents Name *
Parents Email *
PARENTAL WAIVER

I hereby assume all risks of activity (including property loss or damage, personal injury and death) that may result from any sports activity at the Spencer Basketball Fall 3 on 3 League. As parent/guardian, I agree to indemnify, defend and hold harmless the Spencer Community Schools (their officers, employees, agents, instructors) and all participants in the Spencer Basketball 3 on 3 League from and against all liability, including claims and suits at law or in equity, for injury, fatal or otherwise, and property loss or damage which may result from any negligence and/or the student taking part in sports activities. In the event of injury or illness, I give my consent for medical treatment, and permission to camp personnel to supervise or perform on-site first aid for minor injuries and to a licensed physician to hospitalize and secure proper treatment (including injections, anesthesia, surgery, or other reasonable and necessary procedures) for the student. I agree to assume all costs related to any such treatment. I authorize my insurance company to pay benefits for the costs of such treatment. I also authorize the disclosure of medical information to my insurance company for the purpose of any claim. I understand each student must provide his/her own medical insurance. I also understand that I am responsible for any medical or other charges related to the student’s attendance at the Spencer Basketball Fall 3 on 3 League. I certify that the student is physically capable of participating in the camp activities. 

By selecting YES, you are agreeing to the parental waiver form *
Signature of Parent or Guardian (Typing name will act as your signature) *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Spencer Community Schools. Report Abuse