Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthdate *

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DD

YYYY

Gender *

Male

Female

Name *

First Name

Last Name

Home Phone *

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Work Phone *

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Cell Phone *

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Name

First Name

Last Name

Home Phone

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Cell Phone

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Work Phone

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Name *

First Name

Last Name

Phone *

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Agreement *

I, the undersigned, hereby expressly and affirmatively state that I wish my son/daughter to participate in strength and conditioning sessions and/or basketball or volleyball offered through Shasta Magic Athletics. I realize that his/her participation in these activities involves risk of injury, including but not limited to strains, sprains, soft tissue injury, including serious, disabling injuries that may arise due to participation in these activities and that it is not possible to specifically list each and every individual risk. However; knowing the material risks and appreciating knowing and reasonably anticipating that other injuries and even death are possible, I hereby expressly assume all of the delineated risks of injury, all other possible risk of injury, and even risk of death, which could occur by reason of my child’s participation in conditioning activities and/or basketball or volleyball with Shasta Magic Athletics. Shasta Magic Athletics assumes no liability for injury, damage, or death arising from the results of participation in club activities. I have had the opportunity to ask questions. Any questions I have asked have been answered to my complete satisfaction. I subjectively understand the risks of my child’s participation in this activity, and knowing and appreciating these risks, I voluntarily choose for my child to participate, assuming all risks of injury or even death due to participation. I understand that he/she will be participating in activities that include, but are not limited to basketball or volleyball games and training, balance training, foot agility, jumping, endurance training, and reaction training. Due to the strenuous nature of basketball or volleyball, it is urged that the athlete consult with his/her physician concerning his/her fitness to participate.

I/we agree with the above