WAITANGI DAY GOLD COAST 2023
3x3 Basketball Championship

Activity Waiver Form

Please complete and submit the following form prior to your first game.

Player's First Name

Player's Last Name

Email Address

Player's Date of Birth

Waitangi Day Gold Coast 2023 3x3 Basketball Champinoship TEAM NAME

Player's participating who are under 18 require parent/ guardian permission

Parent/ Guardian's First Name

Parent/ Guardian's Last Name

I hereby agree to the following: 1. That I am participating in the training, programs, exercises and events, The Hoop LAB Gold Coast Sessions, Training Sessions offered by Liam Glazebrook, or alternate instructor during which I will receive instruction. 2. I understand that it is my responsibility to consult with a physician prior to and regarding my participating in any The Hoop LAB Gold Coast Program. I represent and warrant that I am physically fit and I have no medical condition that would prevent my full participation in this class. 3. In consideration of being permitted to participate in any Group Session I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the session. 4. In consideration of being permitted to participate in any The Hoop LAB Gold Coast Session I knowingly, voluntarily, and expressly waive any claim I may have against Liam Glazebrook, owners, landlords or insurers or any The Hoop LAB Gold Coast instructor any injury or death caused by their negligence or other acts. 5. I, my heirs or legal representatives forever release, waive, discharge, and covenant not to sue Liam Glazebrook, owners, landlords or insurers or any The Hoop LAB Gold Coast instructor any injury or death caused by their negligence or other acts.

I have read the above release and waiver of liability and fully understand its contents.

I voluntarily agree to the terms and conditions stated above. (Parent’s initials if under 18 years of age) I represent that I have legal capacity and authorize to act on behalf of the minor named herein.

Initials

Today's Date

EMERGENCY CONTACT

Emergency Contact

Emergency Contact Number

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WAITANGI DAY GOLD COAST 2023
3x3 Basketball Championship

Activity Waiver Form

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WAITANGI DAY GOLD COAST 2023 3x3 Basketball Championship Activity Waiver Form

Opening times

LOCATION

contact us

Menu

WAITANGI DAY GOLD COAST 2023
3x3 Basketball Championship

Activity Waiver Form