Insurance Liability Form

There are 4 forms: Insurance Liability Waiver (Blue Form), Registration (White Form), Emergency Contact (Light Blue Form), and Photo/Video Release (Red Form). All of these forms MUST be filled out if you plan to participate in The Rockets Basketball Program.

Players Must Also Register with www.aausports.org to become a member and attain an AAU card.

Health Declaration

PARENTAL CONSENT AND WAIVER OF LIABILITY

I consent to, and give permission for, my child to participate in the Indiana Rockets Basketball Program. I have no knowledge of any physical impairment that would be affected by my child’s participation in the basketball program.

I further agree to waive all liability of the Indiana Rockets Basketball Program, its representatives, employees, Managers, team coaches, School District and any other participant, for any accident, injury, illness or other mishap which might befall the individual named on this registration while traveling to or from, or during their participation in the basketball program, whether or not such liability, claim, damage, loss or expense is caused in part by the negligence of any person, including any negligence by or on behalf of the Indiana Rockets Basketball Program, its agents and specifically including any defects in the condition of the property of the Indiana Rockets Basketball Program or the condition of its maintenance.

I consent to emergency medical care for my child in case of sickness or injury, and any actual charges made for such care. I agree to abide by the rules and regulations as set forth by the Basketball Program for my child’s participation, and that each player will be responsible for herself, her insurance and her equipment. I acknowledge that I have freely and voluntarily entered into this Agreement and that I have read and understand this agreement in its entirety.

I am aware of the nature of this activity, and I hereby assume responsibility for my athlete (NAMED BELOW) to participate and to be photographed and video recorded for publicity purposes.

I will not hold the Indiana Rockets Basketball Program and/or its employees or volunteers responsible in the case of accident or injury as a result of this participation. I understand that this completed form must be in the possession of the Indiana Rockets Basketball Program prior to participation in this program.

I hereby give my consent for the child(ren) listed to participate in the Indiana Rockets/Rockets Elite Basketball Program.

Parent's First Name

Parent's Last Name

Athlete's Name

Athlete's DOB

Email Address

1. HAVE YOU READ THE ABOVE DISCLAIMER AND WAIVER?

Yes

2. Are you suffering from a medical condition, illness, or injury?

Yes

If you answered yes to question #2, please elaborate

Initials

I declare that the info I’ve provided is accurate & complete. Also in checking this box I agree to the terms in the waiver stated above.

Thanks for submitting!