SIPAG-NY BASKETBALL WORKSHOP

with

COACH BOB HURLEY SR

-

JUNE 29, 2024

9 am - 11 am

-

ACADEMY of St. DOROTHY

1305 Hylan Blvd

Staten Island, NY 10305

PLEASE FILL OUT ONE FORM PER PLAYER

In consideration of my participation (or my child, as applicable) in the SIPAG-NY basketball programs and teams and its related events and activities, I, the undersigned fully understand, agree, and acknowledge that:

1. The risks of injury from the activities involved in SIPAG-NY’s basketball programs are significant, including the potential for permanent paralysis and death, and severe social and economic loss, which may result from my own actions, inactions or negligence as well as the actions, inactions and negligence of others. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES (defined below) or others, and assume full responsibility for all risks in connection with my (or my child’s) participation and/or engagement in such events or programs.
2. I further agree to inspect the premises and equipment before playing (or permitting my child to play) each game and if I deem any conditions to be unsafe, I will advise the appropriate persons and will refuse to play (or to allow my child to play, as applicable). I assume all of the foregoing risks and accept personal responsibility for any injury.
3. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY IRREVOCABLY AGREE TO (AND DO HEREBY) RELEASE, INDEMNIFY, AND HOLD HARMLESS SIPAG-NY, CORP. d/b/a SIPAG-NY, its directors, officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), for any claims, demands, suits, actions, causes of action, costs, expenses, losses, awards, judgments, injuries or damages (including reasonable attorney fees and related costs incurred by any of the Releasees) caused or alleged to have been caused by Releasees to myself or my child/children, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, TO THE FULLEST EXTENT PERMITTED BY LAW.
4. I am responsible for ensuring that I (or my child) have been cleared by a physician to participate in the physical activities associated with SIPAG-NY basketball programs. By signing this waiver, I hereby confirm that I have consulted (or I have brought my child to) a physician and that he or she has been cleared to participate in all physical activities of SIPAG-NY basketball programs.
5. I hereby authorize the agents of SIPAG-NY to act for me (or my child) according to their best judgment in any emergency requiring medical attention.

I am of full legal age and have the right to contract in my own name, or that I am the parent, custodial parent, or legal guardian of the child named above and have full legal authority to enter into, and consent of this agreement on his/her behalf.

I HEREBY AFFIRM that by typing my name below, I am signing this APPLICATION, ASSUMPTION OF RISK, WAIVER OF LIABILITY AND RELEASE AGREEMENT electronically. I agree that my electronic signature below is the legal equivalent of my manual signature.

By checking this box, I am the player over 18 years old (or parent/guardian of player) listed above, hereby grant permission to SIPAG-NY representatives, to take and use: photographs, video, and/or digital images of me or my child (if parent/guardian) in news releases as follows: printed publications or materials, electronic publications, or web sites. I agree that my name or my child’s name (if parent/guardian) and identity: may be revealed in descriptive text or commentary in connection with the image(s). I authorize the use of these images without compensation to me. All negatives, prints, and digital reproductions shall be the property of SIPAG-NY.