Celtics Basketball
Assumption of Risk, Waiver, and Release from Liability
I, ___________________________, desire to participate in the Celtics Basketball Sports Program. This Assumption of Risk, Waiver, and Release from Liability covers the entirety of my participation in the Club Sports Program, including travel to any tournaments or any activities associated with the Celtics Sports Program. 1. Risk Factors – I understand and acknowledge that the use of equipment and facilities provided by and participation in the Celtics Sports Program involves risks including, but not limited to the following: risk of property damage, bodily injury. These risks may result from a variety of circumstances including, but not limited to, the use or misuse of the equipment or facilities, from the activity itself, from the acts of myself or others, including the unavailability of emergency medical care. 2. Assumption of Risk – I am participating in the Celtics Basketball Sports Program of my own free will. I understand that my decision to participate in the Club Sports Program is entirely voluntary. I assume full responsibility for all risks that may arise out of, or result from my participation in the Celtics Sports Program, including but not limited to those risks described in Section 1, above. 3. Acknowledgement of Policies and Procedures – I acknowledge that I have read, know, and agree to all of the policies and procedures relating to my participation in the Celtics Basketball Sports Program. I understand that the safe and proper use of all facilities, equipment or participation in the activity is dependent upon carefully following these policies and procedures. I agree to comply with and abide by all rules, regulations and policies of the Rick Cantu Head Coach of the Celtics.. I understand that the Coach Rick reserves the right to remove or terminate my participation in the Celtics Basketball Sports Program for any violations of these rules, regulations, or policies. 4. Release, Indemnify, and Defend – I hereby release, waive, discharge, and hold harmless the Celtics Basketball Sports program , and all of their affiliates, predecessors, successors, trustees, officers, directors, faculty, employees, agents, and representatives, past or present (hereafter jointly referred to as “the Released Parties”) from any and all claims, suits, liabilities, judgments, costs and expenses (“Claims”) for any property damage, property loss or theft, personal injury or illness, death or other loss arising from or relating to my participation in the Celtics Basketball Sports Program. I also agree to defend, indemnify and hold harmless the Released Parties from and against any Claims arising from or relating to my own acts or omissions in connection with my participation in the Club Sports Program. 5. Prerequisite Skills - I acknowledge that I have the requisite skills, qualifications, physical ability, and training necessary to properly and safely participate in the Celtics Basketball Sports Program. I agree that if I have any questions as to what skills, qualifications, or training is necessary to properly participate in the Club Sports Program, then I shall direct such questions to the appropriate individuals. 6. Waiver – I hereby waive any protections afforded by any statute or law in any jurisdiction whose purpose, substance, and/or effect is to provide that a general release shall not extend to claims, material or otherwise, which the person giving the release does not know or suspect to exist at the time of executing the release. This means, in part, that I am releasing unknown future claims. 7. Consent for Emergency Treatment – I consent to medical treatment for emergencies that occur during, or are related to my participation in the Celtics Basketball Sports Program where I am unable to consent to such treatment. 8. Insurance – I understand that I may be solely responsible for any medical, health, or personal injury costs relating to my participation in the Celtics Basketball Sports Program.
I have read and fully understand this Assumption of Risk, Waiver, and Release from Liability and understand that it relates to surrendering and releasing valuable legal rights. I do so freely and voluntarily.
PRINTED NAME: ________________________________ SIGNATURE: __________________ ______________Date: _____________
Consent and Release on Behalf of Minor by Parent/Legal Guardian
I am the parent or legal guardian of the above named minor. I have read and understand this Assumption of Risk, Waiver, and Release from Liability in its entirety and understand that it relates to surrendering valuable legal rights of the minor and myself. I agree to be bound by all the terms of the Assumption of Risk, Waiver, and Release from Liability. I also give my consent to the participation in the activity of the minor.
PRINTED NAME: __________________ ______________SIGNATURE: __________________ ______________Date: _____________

Liability/Waiver Form

Celtics Basketball Sport Program
Assumption of Risk, Waiver, and Release from Liability
Club Sport Name: _______________________________
Grade: _____

Signature: __________________________________
Printed Name: ______________________________
Address: ___________________________________
___________________________________________
___________________________________________
Phone: _____________________________________
Age: ______ Gender: ______

Emergency Contact Information:
Name: _____________________________________
Address: ___________________________________
___________________________________________
___________________________________________
Health Insurance:
Company Name: _____________________________ Policy Number: ______________________________

Date: ______________________________________
UNH ID#: ___________________________________
Permanent: _________________________________
___________________________________________
___________________________________________
Email: _____________________________________
Status: Student Faculty Staff
Other: _____________________________________

Relationship: _______________________________
Phone: _____________________________________