Beruflich Dokumente
Kultur Dokumente
REGISTRATION FORM
Please name one player from your team who will be participating in the skills
competition: Player’s name_________________________
(Each player is required to fill out a waiver form in order to participate in the
tournament.)
*Please keep in mind that all teams are required to check-in between
9:00a.m-9:30a.m to ensure that they receive their tournament jersey and are
placed in the bracket.
Name _________________________________________________________________________
Age ___________ Grade ____________ School _________________________Sex: M or F
Home Address ______________________________________________________Neighborhood___________________
City _______________________________ State ______Zip Code _____________Birth date ______________________
Email Address______________________________________________________________________________________
Home Phone # ________________________________________Cell Phone # __________________________________
Emergency Information:
AGREEMENT:
I have read and fully understand the above information on Policies and Procedures.
Assumption of Risk & Waiver of Liability:
As the legal guardian of ________________________, I recognize the possibility of injury ranging from minor injury to terminality while participating in
activities and events with Kingdom Impact/ New Hope International (KI/ NHI) that include, but are not limited to cheerleading, tumbling, dance,
basketball, open gym, etc. With the knowledge of these possible risks, I grant permission for participation by the aforesaid in KI activities and events. I,
my administrators, executors, and/or other representatives vow to waive and release all liability for any and all damages/injuries endured by the
aforesaid while under the instruction or supervision of KI/ NHI and/or its representatives, including but not limited to transportation to and from KI/ NHI
activities and events.
I recognize that KI/ NHI staff and representatives are not certified medical practitioners of any kind. With this knowledge, I authorize basic first aid
treatment by KI/ NHI staff and representatives to the aforesaid in the event of illness or injury. If deemed necessary by KI/ NHI staff or representatives, I
give permission for the aforesaid to be transported to any health care facility or hospital by a KI/ NHI staff member or representative or via an
ambulance. I release the physician to administer x-rays, perform exams, and/or medical/surgical diagnosis in the event of an emergency. I confirm that
the aforesaid is currently covered by medical insurance, that he/she will continually have coverage throughout the duration of participation with KI/ NHI,
and that I personally, or through my health insurance agency, will provide payment for these expenses and for those expenses incurred in the future as
a result of the injury endured while under KI/ NHI instruction or supervision.
As the responsible guardian, I will inform the aforesaid of the possibility of injury associated with participation with KI/NHI, encourage following all Safety
Rules, and stress the importance of following instruction of KI/NHI staff so as to decrease the risk of injury.