Parent Consent, Terms & Conditions

As a parent/legal guardian of the specified minor (hereinafter referred to as “participant”). I do hereby give permission for him/her to attend, participate in, and be photographed/video-taped by the Cleveland Basketball program.

I understand that if something should happen to participant during the above-noted activities that requires my attention, the adults in whose care the participant has been entrusted will try to reach me using the emergency contact information I provided below. In the event I cannot be reached immediately,

I authorize said adults to consent to any x-ray examination, anesthetic, hospital care, medical/surgical/dental diagnosis or treatment to be rendered to the participant under the general or special supervision of any licensed health care practitioner or medical treatment facility.

I consent to being held liable for, and agree to pay for, all costs and expenses incurred in connection with such medical or dental services rendered to the aforementioned participant pursuant to this authorization.

I shall assume all transportation costs, should it be necessary for the participant to return home from said activities for medical or other reasons.

I certify that I am a parent or a legal guardian of the participant named on this form. As part of the agreement allowing the participant named on this form to participate in this activity, I hereby release Cleveland High School and Cleveland Basketball, its staff, employees and any persons acting on its behalf, from any and all liability (including claims based upon negligence) for personal injury and/or property damage/loss to myself and the participant named on this form.