Please complete the following form to create a Team App account and join Rogue Basketball.
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(BY TYPING FULL NAME IN THE BOX BELOW YOU AGREE TO FOLLOWING)
Both my/our child and myself/ourselves are familiar with the risk associated with participation in an active sport such as basketball. Furthermore, I/we warrant that my/our child is in good health and has no condition which would interfere with his/her participation in this club. I do hereby agree and consent to my/our child’s participation in Rogue Basketball and assume all risks and hazards which are incidental to the conduct of its activities. I/we hereby release, absolve, indemnify and hold harmless Rogue Basketball, the sponsors of the club, Rogue Basketball coaches, agents and volunteers. This includes owners or parent organization of any facility where the games and practices are held of any kind of liability or damage, injury or expense of any kind arising out of or connected with my child’s participation with Rogue Basketball.
I/WE ACKNOWLEDGE THAT I/WE HAVE READ THIS CONSENT FORM AND KNOWINGLY, ON BEHALF OF MY/OUR CHILD_________________________________, ASSUME ALL RISKS ASSOCIATED WITH PARTICIPATION IN ANY WAY WITH ROGUE BASKETBALL.
I (We) the undersigned parent(s)/legal guardian of ___________________________, a minor do hereby authorize and consent to any x-ray examination, anesthetic, medical or surgical diagnosis rendered under the general or special supervision of any member of the medical staff and emergency room staff licensed under the provisions of the Medicine Practice Act or a Dentist licensed under the provisions of the Dental Practice Act and on the staff of any emergency general hospital holding a current license to operate a hospital from the Department of Public Health in the state which the team is traveling and seeking medical or dental care. It is understood that this authorization is given in advance of a specific diagnosis, treatment or hospital care being required but is given to provide authority and power to render care which the aforementioned physician in the exercise of his best judgment may deem advisable. It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatment will not be withheld if the undersigned cannot be reached.
