Participant's Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Gender *

Boy

Girl

Parent/Guardian *

First Name

Last Name

Liability Waiver (Parent/Guardian Electronic Signature Required) *

As the parent and/or legal guardian of the above named minor, I grant permission to participate in all activities of the sports program. I assume all risk and hazards incidental to such participation, including transportation to and from such activities, and do hereby release and waive all claims against SBA/Lynnwood Select Basketball members, staff, coaches, volunteers, sponsors, and all school districts we may participate in. *PLEASE FILL WITH LEGAL FIRST NAME AND LAST NAME*

First Name

Last Name

HB 1824 Compliance Statement (Parent/Guardian Electronic Signature Required) *

I have been provided with information on concussions in youth sports. If the player is suspected of a head injury or concussion, the player will be removed from play. The player will be kept from play until given permission to return to play by a health care provider. https://www.cdc.gov/headsup/youthsports/index.html *PLEASE FILL WITH LEGAL FIRST NAME AND LAST NAME*

First Name

Last Name

Code of Conduct Policy (Parent/Guardian Electronic Signature Required) *

As the parent/guardian of the above named participant, I understand the the Code of Conduct Policy and agree that the named participant understands and conducts themselves in a manner that is consistent with the league they are participating in. I, as the parent/guardian will sign on behalf of the participant so that they may take part in SBA/Lynnwood Select Basketball activities. Breaking Code of Conduct Policy could result in the expulsion of the participant from the SBA/Lynnwood Select Basketball Program. *PLEASE FILL WITH LEGAL FIRST NAME AND LAST NAME*

First Name

Last Name