Liability Waiver

Please complete the form below for each child registered to participate in the CDBL program.

Boy's Name

First Name

Last Name

I/We, the parents of the above-named child participating in the Concord Developmental Basketball League (CDBL), hereby give my/our approval to participate in any and all Concord Developmental Basketball League activities. I/We represent that my child resides in the Concord School District. I/We acknowledge that the sport of basketball, in general, and participation in the Concord Developmental Basketball League, specifically, can be a physically taxing activity and may result in serious injuries to participants. I/We do hereby waive, release, absolve, indemnify and agree to hold harmless the Concord Developmental Basketball League, Concord Community School Corporation, their organizers, volunteers, sponsors, supervisors, employees, coaches, officers, directors and participants from any claim made by or on behalf of anyone arising from my/our child’s participation in Concord Developmental Basketball League, regardless of the nature of the claim. I/We will furnish a certified birth certificate of the above-named candidate to league officials, upon their request. I/We will furnish a copy of family insurance/medical plan card, upon league official’s request.

Please type your initials in the box below. By doing so, you acknowledge these terms.

Parent's full name with whom the child resides - Parent 1

First Name

Last Name

Parent's full name with whom the child resides - Parent 2

First Name

Last Name

Emergency contact phone number during League time

(###)

###

####

List any physical limitations your child may have

Family medical insurance plan - Insurance company name

Family medical insurance plan - Group number

I/We hereby grant medical authorities to administer emergency medical treatment to the above child in case I am not present and could not be contacted after a reasonable attempt. Parent/ Guardian signature below indicates a clear understanding and agreement of all information provided in this document. Please type parent's full name in the box below.

Parent/Guardian Signature (type full name)

In addition by signing this waiver, CDBL has permission to post pictures of your registered participant(s) on its website and social media platforms.

Parent/Guardian Signature (type full name)