Registration: June 23rd -26th Basketball Camp

Name

First

Last

Confirm Email

Phone

How many players are you registering?

One
Two
Three
Four

Grade in Fall Semester

Player Height

Fall Waiver 3)

Insurance Provider

Insurance Company Phone

Policy & Group #

Policy Holder Name

Release of Liability and Waiver of Claims

I am the parent or legal guardian of the child (“Youth”) identified during this registration to participate in one or more programs (“Programs” and each a “Program”) offered by Lee Humphrey Basketball, LLC, a Florida limited liability company (“LHB”), and wish for Youth to participate in such Programs.  I understand and have explained to Youth that participation in a Program involves risk, including intentional or unintentional acts/events arising from circumstances or individuals over which LHB has limited or no control.  On behalf of Youth, myself, and any other person who may claim through or on behalf of Youth (collectively, “Participant Parties”), Youth and I assume all risks and hazards inherent in, incidental to, or pertaining in any way to the Programs, including, without limitation, property damage, mental, physical, emotional, and bodily injuries, and/or death, caused by or resulting in any way from participation in a Program, whether caused in any way by me; any other adult, child, or participant; or the conditions of the property, equipment, or surrounding areas.   In consideration for Youth’s participation in a Program, I, on behalf of all Participant Parties and each of our respective heirs, successors and assigns, agree to, and do hereby, discharge, release and waive any claims, damages, lawsuits, and/or causes of action (together, “Claims”) against LHB and its respective affiliates, officers, directors, landlord (and any other owners of the property, land or facilities on which LHB operates or any Program is conducted), employees, agents, coaches, volunteers, staff, representatives, contractors, successors, and assigns (collectively, the “Releasees”), including any Claims for personal injury, death, or property loss or damage arising out of or in any way related to Youth’s or any other Participant Party’s participation in any Program (including, without limitation, use of LHB’s facilities or equipment, or the facilities, land or equipment of any other person, or travel to or from a Program event), whether caused in part or in whole by the negligence or other actions of Releasees or any other person.  I further covenant not to sue the Releasees for any Claim released under this Release of Liability, Waiver of Claims, and Authorization of Medical Care, and agree to indemnify, defend and hold harmless (including payment of reasonable attorneys’ fees, costs, and insurance deductibles) the Releasees with respect to any such Claims.   In addition to the foregoing, I, on behalf of all Participant Parties, hereby request and a grant permission to LHB to authorize emergency medical treatment for Youth (including through an athletic trainer, coach, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry and any personnel associated with the foregoing), if necessary, and I assume personal and financial responsibility for any medical care and treatment that Youth may require as a result of volunteering and participating in the Programs.  I also authorize emergency transportation of Youth to a medical treatment facility should an individual listed above consider it to be warranted.  The Participant Parties agree to release, discharge, and indemnify the Releasees from any Claim based on such transportation or other medical care.   I understand that this Participant Release of Liability, Waiver of Claims, and Authorization of Medical Care is a contract between the Participant Parties and LHB.  I sign it of my own free will.  I also understand that this contract is severable and if any part of it is held by a court of law to be unenforceable, the rest shall survive.    I HAVE CAREFULLY READ THIS PARTICIPANT RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND AUTHORIZATION OF MEDICAL CARE AND FULLY UNDERSTAND ITS CONTENTS.  I UNDERSTAND THAT BY SIGNING THIS RELEASE I AM GIVING UP VALUABLE RIGHTS.   By checking the “I agree” box and clicking “Continue,” I represent and warrant that I am the parent or legal guardian of Youth and intend, on behalf of Youth, myself and each other Participant Party, to electronically sign and be bound by this Participant Release of Liability, Waiver of Claims, and Authorization of Medical Care.

Signature

I agree to the terms of the Release of Liability and Waiver of Claims and that my typed name is my electronic signature.

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