[INSERT HEADER OF THE MEN’S BASKETBALL MINISTRY]

LIABILITY AND MEDICAL RELEASE

I _______________________________________________________________________, of legal
age hereby agree to hold the CCF MEN’S BASKETBALL MINISTRY and their duly
authorized representatives, free from any liability, claims or demands in
connection with my participation in the CCF MEN’S BASKETBALL MINISTRY’s
TOURNAMENT.

In emergency cases, I hereby grant permission to CCF MEN’S

BASKETBALL MINISTRY and their duly authorized representatives to administer
medical treatment and take me to the hospital if advised by the tournament’s medical
team. Moreover, I voluntarily agree that I will solely shoulder the consequent expenses.

____________________________ ______________________________________
Guardian’s Signature Over Printed Name Authorized Representative’s Signature Over Printed Name

Contact Information:

Participant’s Contact No._____________________

Address:____________________________________________________________________________

In case of emergency please contact:

Name:___________________________________ Relationship:_________________________

Cellphone No.________________________

Medical Data:

Blood Type:_________

Allergies:_________________________________________

Other Health Concerns: