2021 Summer Camp Registration 1 Session (s) Attending2 Player Information3 Contact Information4 Parent Release 5 Payment Session (s) Attending* Session 4: July 5-July 9 Session 5: July 12-July 16 Session 6: July 19-July 23 WEEK 1 - SOLD OUT / WEEK 2 - SOLD OUT/WEEK 3 - SOLD OUT Player Name* First Last Height*Weight*Age*Grade*School* Email* Phone*Cell Phone*Emergency Phone*Address* Street Address City State / Province / Region ZIP / Postal Code You MUST READ & AGREE to this Waiver before being enrolled in Lightning Basketball Camp. Sport(s): 1. Waiver of Liability, Assumption of Risk, and Indemnity Agreement Waiver: In consideration of being permitted to participate in any way in Lightning Basketball Camp. I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue Lightning Basketball Inc. and its officers, employees, and agents from liability from any and all claims including the negligence of Lightning Basketball Inc. and its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in Lightning Basketball Camp. Assumption of Risks: Participation in the Lightning Basketball Camps carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to 3) catastrophic injuries including paralysis and death. I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in Lightning Basketball Camps. I hereby assert that my participation is voluntary and that I knowingly assume all such risks. Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD Lightning Basketball Inc. their respective officers, employees, and agents, HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in Lightning Basketball Camps and to reimburse them for any such expenses incurred. Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of Florida and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. 2. Permission for Use of Image and Statements I hereby grant to Lightning Basketball Inc. permission to reproduce the above minor’s and/or participant’s likeness, identity, voice, photographic image, videographic image and oral or recorded statements in any publication of Lightning Basketball Inc. intended for research, educational, promotional, fund-raising or other related use, including but not limited to, film broadcast, printed publications, webpages and web-based publications, associated with Lightning Basketball Inc. . By clicking Yes below on the form, I waive and release Lightning Basketball Inc. and its officers, agents and employees, from any claim or liability relating to the use of my likeness, identity, voice, photographic image, videographic image and oral or recorded statements. I acknowledge that Lightning Basketball Inc. will rely on this permission and release in producing, broadcasting, and distributing materials containing my likeness, identity, voice, photographic image, videographic image or oral or recorded statements, and that I will receive no money or remuneration of any kind from Lightning Basketball Inc. related to this permission and release or the materials covered by this permission and release. Acknowledgment of Understanding: I have read both (1) the waiver of liability, assumption of risk, and indemnity agreement, and (2) permission to use my image, and fully understand the terms. I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law. I am an adult, 18 years or older, and I have read and understand this agreement and I freely and knowingly give my consent to Lightning Basketball Inc. as described herein. If I am a minor, I, along with my Parent/Guardian, have read and understand this agreement and through my Parent/Guardian freely and knowingly give my consent to Lightning Basketball Inc. as described herein. 3. Release Authorization For Emergency Treatment I understand that I am required to maintain and carry accident medical insurance coverage for the child listed on this application and I verify that the coverage information attached herewith is accurate and true. In the case of an emergency, and I cannot be reached. I authorize the staff of Lightning Basketball Inc. to obtain whatever medical treatment he/she deems necessary for the welfare of my child listed on this application. I further understand that I will be financially responsible for all charges and fess incurred in the rendering of said emergency treatment, regardless of whether or not my medical insurance would cover such charges and fees. Parent Release*Yes, I READ and AGREE to the Parent Release FormNo, I DO NOT AGREE (Choosing this will stop the application)Medical Insurance Company*Policy Number*Authorize Enrollment of Treatment* YES, I Authorize Treatment Parent/Guardian Name* First Last Date* Date Format: MM slash DD slash YYYY (Format: mm/dd/yyyy)You MUST READ & AGREE to this Waiver before being enrolled in Lightning Basketball Camp. WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-191. Waiver of Liability, Assumption of Risk, and Indemnity Agreement ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT In consideration of being allowed to participate on behalf of (insert name of sports organization) athletic program and related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS (insert name of sports organization) their 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”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION) This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law. Covid-19 Parent Release*Yes, I READ and AGREE to the Parent Release FormNo, I DO NOT AGREE (Choosing this will stop the application) Payment Method*Pay Online/Pay PalRegister Online/Send CheckCommentsThis field is for validation purposes and should be left unchanged.