Primary Parent/Guardian Name *

Parent/Guardian who needs to receive team communication and serves as primary emergency contact

First Name

Last Name

Primary Parent / Guardian Phone Number *

Parent/Guardian who needs to receive team communication and serves as primary emergency contact

(###)

###

####

Secondary Parent/Guardian Name

Parent/Guardian who needs to receive team communication and serves as an emergency contact

First Name

Last Name

Secondary Parent / Guardian Phone Number

Parent/Guardian who needs to receive team communication and serves as an emergency contact

(###)

###

####

Player Name *

First Name

Last Name

Player Birthday *

MM

DD

YYYY

PARENT/GUARDIAN & PLAYER ACKNOWLEDGEMENT AND AGREEMENT WITH COURTSIDE UNITED BASKETBALL CLUB POLICIES *

I agree to adhere to the Terms & Conditions, Policies, and Code of Conduct of Courtside United Basketball Club. My athlete and I have read and agree to the club guidelines and policies - Liability Waiver and Medical Release, Media Consent, Player / Parent Code of Conduct, Covid-19 Cleared to Participate. I represent that I am the parent or guardian with legal responsibility for the athlete I am registering (the minor “Participant”). In consideration for allowing Participant to voluntarily participate in Courtside 360 (“CS360”) and all related activities (collectively the “Activities”), I, on behalf of myself and the Participant, the Participant’s parents and family, and its or their agents, personal representatives, next of kin, heirs and assigns (collectively the “Waiving Parties”) HEREBY RELEASE AND WAIVE ANY AND ALL CLAIMS OF WHATEVER KIND OR CHARACTER, WHETHER ARISING IN CONTRACT OR IN TORT, AND INCLUDING WITHOUT LIMITATION FOR NEGLIGENCE OR GROSS NEGLIGENCE, THAT WAIVING PARTIES MAY HAVE AGAINST THE RELEASED PARTIES FOR PERSONAL INJURY, ACCIDENT, DISFIGUREMENT, MEDICAL EXPENSES, LOST WAGES, LOSS OF EARNING CAPACITY, ATTORNEYS’ FEES, COURT COSTS OR PROPERTY DAMAGE RESULTING IN WHOLE OR PART FROM ANY PARTICIPATION IN THE ACTIVITIES. The “Released Parties” are CS360; owners and lessors of any premises used to conduct the Activities; sponsors; any parent, subsidiary, affiliate, predecessor, successor, or assign of the entities named or described in; any current, former, or future officer, director, partner, owner, member, manager, agent, employee, representative of the entities named or described in; any instructor or coach; and any other participant. I hereby certify that the Participant is in good health, has been monitored and is free from Covid-19 symptoms, and is cleared by a physician and may take part in all Activities not limited to, but including tryouts, training, practices, and games. I acknowledge that it is the express intent of CS360 to provide for the safety and protection of my child, but acknowledge that potential severe injuries can occur in any activity associated with basketball. I acknowledge that CS360 does not carry Participant medical insurance. I acknowledge that if I do not already possess current medical insurance, I have been advised to secure health insurance on my Participant prior to participation in CS360 Activities. I hereby agree to individually provide for the possible medical expenses which may be incurred by my Participant as a result of any injury sustained while training, practicing, or competing in CS360 Activities. I authorize the Released Parties to obtain emergency medical treatment for Participant, including, if necessary, surgical procedures, if Participant is injured or becomes ill during the Activities, even if the Released Parties are unable to contact me. I further agree that any expenses for medical treatment received by Participant as a result of any injury or illness during the Activities is my sole responsibility. I hereby authorize and grant to CS360 the right to: record me (including, without limitation, my appearance, image and voice) by still photography and videotape photography, audio tape and all other means of recording technology (the results of which shall be deemed the “Recordings”); edit the Recordings (in the CS360’s sole discretion); use the Recordings along with my name, photographs, likenesses and voice; in and in connection with CS360, the Activities, and all ancillary and subsidiary uses thereof and all advertising and publicity in connection with CS360 and the Activities and to exploit the Recordings for the benefit of CS360 in any and all manner and media now known or hereafter devised, throughout the world, in perpetuity. I hereby represent and warrant that I have the right to grant the rights granted hereunder. I expressly release the Released Parties from and against any and all claims which I have or may have for invasion of privacy, defamation or any other cause of action arising out of the production, distribution, broadcast or exploitation of the Recordings. I acknowledge and agree that in no event shall I seek or be entitled to obtain injunctive or other equitable relief against the Released Parties or the Recordings. BY ELECTRONICALLY ACCEPTING AND AGREEING TO THESE POLICIES AND GUIDELINES, I REPRESENT THAT I HAVE CAREFULLY READ THIS WAIVER AND RELEASE, AUTHORIZATON, AND ACKNOWLEGDEMENT AND FULLY UNDERSTANDAND AND AGREE TO ITS CONTENTS. I ACKNOWLEDGE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND COURTSIDE 360, COURTSIDE UNITED BASKETBALL CLUB, AND SIGNING IT IS OF MY OWN FREE WILL.