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             LIABILITY RELEASE

As a parent/legal guardian of the above participant, knowing that safe
procedures and practices will be employed by NICMAR, its officers, administrators, partners,
and affiliates, I will not hold NICMAR nor its officers, administrators, partners, or affiliates liable for any injuries that may occur during the conduct of my child's participation. I also understand that NICMAR nor its officers, administators, partners, or affiliates provides neither hospitalization nor any type of accident insurance for its participants.

I am aware NICMAR, its officers, administrators, partners, and affiliates assume no liability for injuries or damages arising form the result of participating.

I have been informed by NICMAR that due to the strenuous nature of some activities; participants are urged to consult their physician concerning fitness to participate. All activities present certain inherent risks and hazards, which I am urged to consider and which the participant and his/her parents assume.

In the event of an emergency, I hereby give consent to emergency medical treatment for my child on my behalf. To the best of my knowledge, there are no physical or other conditions that will interfere with my child's participation. By submitting this registration form means I have read and agree with the content within.

 

 


First Name
Middle Name
Last Name
Address Line 1
City
State
Zip Code
Age
Birthday
Grade
School Attending
Basketball Coach's Name
Daytime Phone() -
E-mail Address
Parent or Legal Guardian
Parent or Legal Guardian: Phone() -
Emergency contact:
Emergency contact Phone:() -
Relationship
Physician
Phone #: () -
Medical Insurance Co
ID #
Medical Conditions to be aware of:
                  
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