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Waiver Form

  /  Waiver Form

WAIVER OF LIABILITY, MEDICAL RELEASE, AND INDEMNIFICATION AGREEMENT

I  hereby voluntarily commit to participate in the Florence Wildcats

Organization tryouts (Men’s) for the 2021-2022 Basketball season.

I UNDERSTAND AND FULLY ACCEPT THAT THERE ARE RISKS INVOLVED IN SPORTS, AND THAT

ACCIDENTS AND INJURIES ARE COMMON AND ARE ORDINARY OCCURRENCES. I HEREBY AGREE  

As consideration for being permitted by The Florence Wildcats Organization to participate in this activity, I hereby release and hold harmless the officers, employees, volunteers, designated coaches, and agents of The Florence Wildcats Organization (“TFWO Personnel”), jointly and severally, from all liability, and from all actions or claims that I now or hereafter have for damage or injury to myself, and/or to any person or property, resulting from the negligence or other acts of any employees or volunteers in connection with my participation. I further agree that this waiver, release and assumption of risks are to be binding on the heirs and assigns of the undersigned.

I further agree to indemnify and to hold TFWO Personnel free and harmless from any

loss, liability, damage, cost or expense which they may incur as a result of any injury and/or property damage that I may cause or sustain while participating in this activity.

In case of a medical emergency involving myself, I hereby give permission to TFWO Personnel to authorize medical treatment as recommended by emergency medical professionals.

including X rays. I also hereby give permission to TFWO Personnel to disclose to medical professionals any medical information related to the treatment and/or care of to myself. I understand that an attempt will be made to reach me by phone as soon as possible. I acknowledge that the Williamstown Youth Center does not provide any medical or other insurance protection for my child or me and as such I agree to pay all medical, hospital, or other expenses which my child or I may incur as a result of injury and/or medical treatment I have authorized herein.

I HAVE CAREFULLY READ THIS RELEASE, WAIVER AND INDEMNIFICATION AGREEMENT AND

FULLY UNDERSTAND ITS CONTENTS; I AM SIGNING THIS DOCUMENT OF MY OWN FREE WILL AND I’M THAT MY SIGNATURE BINDS ME TO A CONTRAC WITH THE FLORENCE WILDCATS ORGANIZATION PERSONNEL.

TO ACCEPT ANY AND ALL RISKS OF INJURY OR DEATH, AND VERIFY THIS STATEMENT BY PLACING MY INITIALS HERE. 

  

Player Information:


Position(s), Weight/Height & Experience: (PG – C | High School, College, etc.)


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