Parent/Guardian Authorization & Waiver of Liability

1. Parent/Guardian Authorization & Waiver of Liability To induce the Howell Basketball Club to accept registration and permit participation in HBC by the named child, I the parent or legal guardian of said individual, hereby give my consent and agree to release, indemnify, and hold harmless HBC, its officials, coaches and representatives from any claim arising out of injury to the named individual except to the extent and in the amount covered by the HBC accident reimbursement program and/or liability insurance held by HBC. Parent/Guardian Signature Date Player/Child Health Statement This section is an HBC insurance requirement. It must be completed, signed, and presented to the proper HBC representative prior to participating in the Intramural Clinics, practices, or season league play. Children will not be permitted to participate until this completed, signed section has been received by an HBC Board of Director or member. Child’s Name: List any physical limitation (allergies, hearing, sight, asthma, eyeglasses, lymes, etc) Parent/Guardian SignatureDate: HBC 5th Grade Intramural Program Waiver of Liability & Child Health Statement