Kids Clinic: Basketball

Name of Participant*

First Last

Gender*

Birth Date*

Age*

Parent Information

Name*

First Last

Email*

EAST-WEST ALL-STAR GAMES KIDS’ CLINIC ACTIVITY and PUBLICITY AUTHORIZATION, WAIVER AND LIABILITY RELEASE

In consideration for being permitted to participate in the athletic and related activities as may comprise the East-West All-Star Games Kids’ Clinic (hereinafter “Activities”) and for good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I (parent/guardian listed above) as parent or legal guardian of participant listed above , a minor (hereinafter “Minor”), on my own behalf and on behalf of Minor, hereby approve and execute this authorization, waiver, and liability release (“Authorization and Liability Release”) and grant the permission necessary to allow Minor to participate in the Activities as may be conducted by the The North Carolina Coaches Association and its representatives and volunteers (collectively, “Association”).

I, on my own behalf and on behalf of Minor, further agree to release, hold harmless, and indemnify Association as well as the respective directors, officers, representatives, members, agents, volunteers, and employees of Association, the City of Greensboro, the Guilford County Board of Education, Grimsley Senior High School, and all other participants in and sponsors of the Activities (hereinafter collectively “Releasees”) from any and all liability, whether caused by the negligence of Releasees or by any other persons or entities, for and from any and all claims, demands, actions, judgments, losses, damages, liabilities, costs and expenses (including, without limitations, attorney’s fees and costs)(collectively “Claims”) arising out of or connected with the Activities, including any Claims arising out of or connected with any illness or injury (minimal, serious, catastrophic and/or death) that Minor may incur or sustain during the Activities. I further expressly agree to indemnify, hold harmless, and defend Releasees (with counsel of Releasees choosing) against any claims, demands or actions that may subsequently be brought by Minor or by any other persons on the account of damages or injuries of any character or nature resulting to or sustained by Minor in any way from the Activities. I further agree to reimburse and to make good to Releasees any loss or costs Releasees may have to pay as a result of any such action, claim, or demand.

I, on my own behalf and on behalf of Minor, acknowledge and agree that participation in the Activities subjects Minor to possible physical illness or injury (minimal, serious, catastrophic and/or death) and that Minor is assuming all risks, known and unknown, of such illness or injury by participating in the Activities. I further acknowledge and understand that I will be responsible for any and all medical and related bills incurred by or on behalf of Minor for any illness or injury that Minor may sustain during the Activities.

Authorization, Waiver and Liability Release

I, on my own behalf and on behalf of Minor, hereby warrant that I have read this Authorization and Liability Release in its entirety and fully understand its contents, am aware that it releases Association and all Releasees from any and all liability and contains an acknowledgment of my voluntary and knowing assumption of the risk of physical illness or injury to Minor. I, on my own behalf and on behalf of Minor, further acknowledge that nothing in this Authorization and Liability Release constitutes a guarantee that the Activities occur. By signing below, I acknowledge that I, on my own behalf and on behalf of Minor, have signed this document voluntarily and of my own free will.

Promotion and Publicity Authorization:*

I understand that Association may produce promotional material, newsletter stories, and/or other written, video, or photographic materials relating to the Activities (“Promotional Materials”). I understand, as a participant and/or a spectator, that Minor may be included in Promotional Materials created during the Activities. Therefore, without reservation or limitations and without further consideration, I, on my own behalf and on behalf of Minor, hereby assign, transfer and grant to Association, its successors, assignees, licensees, sponsors, videographers, and photographers the exclusive right to photograph and/or videotape Minor and to utilize such Promotional Materials and Minor’s name, image, likeness, voice and appearance as part of the Activities, in advertising, reporting on, and promoting the Activities or advertising and promoting similar Activities in the future. I further understand that neither Association nor any third party is under any obligation to exercise any of the foregoing rights, licenses and privileges.

Signature

Parent/Guardian Signature*

NCCA Kids Clinic- Basketball

Parent Information

EAST-WEST ALL-STAR GAMES KIDS’ CLINIC ACTIVITY and PUBLICITY AUTHORIZATION, WAIVER AND LIABILITY RELEASE

Signature