5Th/6Th Boys Basketball

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5th/6th Boys Basketball (Fee $50.00/$40.00 2^nd child)

Participant's Information

Name:

Date of Birth:

Age:

Gender:

Shirt Size:

Parent or Guardian

Name:

Email:

Phone:

Cell Phone:

Scholarship (one per family) *Will need Form

YesNo

Address

Address:

City:

State:

Zip:

Is mailing address same:

NoYes

Mailing Address

Address:

City:

State:

Zip:

NOTE: If using a SCHOLARSHIP (one per family), the $50.00 fee will apply to your next child. Then $40.00 if same age group/sport.

Emergency Contact (other than above)

Name:

Relationship:

Phone:

Cell Phone:

Payment

CHECKS PAYABLE TO : Town of De Beque

Check #:

Amount:

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Waiver / Release

acknowledge that I have voluntarily applied to participate in De Beque Recreation sponsored programs.

I understand and recognize that there are specific risks of physical or property damages, losses, injuries, or even death that my result in my participation or attendance at the Town of De Beque property, De Beque School District J49 property or any other properties leased or used by the Town of De Beque. I voluntarily assume the risks associated with such participation and attendance. I acknowledge that I am in good health with no physical defects that would prevent me from engaging in these activities. I willingly assume the risk of injury as my sole responsibility. De Beque recreation is NOT responsible for any personal items lost or stolen.

I understand and agree that any bodily injury, death, damage, or loss of personal property and expenses as a result of my negligence or the negligence of the Town are my responsibility. As lawful consideration for being permitted to participate in any De Beque Recreation programs I release from any legal liability and agree not to sue, claim against the property of, or prosecute, and to indemnify and hold harmless, the Town of DeBeque and all of its officers, agents and employees, coaches, volunteers, and other participants for any and all liability, injury or death caused by or resulting from my voluntary participation in the baseball program whether or not such liability, injury or death was caused by their negligence, my negligence or any other cause.

In addition, I authorize any medical treatment deemed necessary or appropriate by the instructor, any emergency technician, nurse or physician in case of illness or injury while participating in De Beque Recreation programs. I understand that this permit is to prevent undue delay and assure prompt treatment, Participants involved in De Beque Recreation programs may be photographed and such photographs may be used to publicize city activities.
This Waiver and Release of Liability shall be legally binding upon me, my heirs, my estate, assigns, legal guardians and my personal representatives.

I have carefully read this Release and fully understand its contents. I am aware that I am releasing legal rights that I otherwise may have and I enter into this agreement of my own free will, and with full understanding and awareness of the risks involved. I agree to assume such risks.

This is a release of liability. Do Not Sign the release if you have not read it completely or do not understand or do not agree with an y of its terms.

I am the parent or legal guardian of the above named participant and I hereby consent to the above waiver and release of liability on behalf of my child in accordance with Colorado Law.

Date:

Participant:

Date:

Parent / Guardian:

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