List every child this waiver covers. Required fields are marked with *.
Medical — what we need to know: food, medication, or insect allergies (and whether an EpiPen is carried), asthma or an inhaler, diabetes, seizures, heart conditions, prior concussions, current or recent injuries, or anything else a coach should know in an emergency. Type “none” if there’s nothing.
Someone other than you that we can call if we can’t reach you.
ASSUMPTION OF RISK
I understand that basketball is a physical sport and that participation in PYBA activities — including tryouts, open gyms, practices, games, tournaments, and travel to and from them — involves risk of injury, including but not limited to sprains, fractures, concussions, and in rare cases serious injury, paralysis, or death. I understand these risks cannot be eliminated even with proper coaching, equipment, and supervision. I knowingly and voluntarily accept these risks on behalf of the player(s) listed above.
RELEASE AND WAIVER OF LIABILITY
In consideration of being allowed to participate, I, for myself and on behalf of the player(s) listed above and our heirs and assigns, release, waive, and agree not to sue Pillager Youth Basketball Association, its board members, coaches, volunteers, evaluators, sponsors, and Pillager Public Schools and its staff (the “Released Parties”) from any and all claims, demands, or causes of action arising out of participation in PYBA activities, including claims arising from the ordinary negligence of the Released Parties, to the fullest extent permitted by Minnesota law. This release does not apply to gross negligence or willful misconduct.
MEDICAL AUTHORIZATION
If I cannot be reached in an emergency, I authorize PYBA coaches or volunteers to obtain emergency medical treatment for the player(s) listed above, and I accept responsibility for the cost of that care. I confirm the player(s) are physically able to participate. I have listed each player’s medical needs above and will tell PYBA if anything changes.
CODE OF CONDUCT AND PHOTO RELEASE
The player(s) and I agree to show respect to coaches, officials, opponents, and facilities, and understand that PYBA may remove a player or spectator for unsportsmanlike conduct. I give PYBA permission to use photos or video of the player(s) taken at PYBA activities on its website, social media, and printed materials, without compensation, unless I check the box below to decline.