www.communitykinshipcoalition.

org

CVIL 3 on 3 BASKETBALL REGISTRATION FORM

Email completed form to bksckc@gmail.com by Wednesday, May 15, 2024.

Municipality:
Contact Person: Title Phone: Email:

Player 1
First: Last: Age: Grade:

Emergency Contact:

Relationship to participant: □ Parent/Guardian □ other Contact Number: Email:

Player 2
First: Last: Age: Grade:

Emergency Contact:

Relationship to participant: □ Parent/Guardian □ other Contact Number: Email:

Player 3
First: Last: Age: Grade:

Emergency Contact:

Relationship to participant: □ Parent/Guardian □ other Contact Number: Email:

Player 4
First: Last: Age: Grade:

Emergency Contact:

Relationship to participant: □ Parent/Guardian □ other Contact Number: Email:

Authorized Representative
First: Last:

Relationship to participant: □ Parent/Guardian □ Coach □ other Contact Number: Email:

“People Empowering People Towards Positive Change”

 www.communitykinshipcoalition.org

CVIL 3 on 3 BASKETBALL WAIVER FORM

Community Kinship Coalition Inc, CVIL 3 on 3 Basketball Tournament Waiver The acknowledgement of this
waiver via signature of an adult, either the adult team representative or a parent or guardian, is required in
order to participate in the Community Kinship Coalition Inc, CVIL 3 on 3 Basketball Tournament.

By signing below, I acknowledge that I am aware of and accept the risks involved in participating in this activity
and hereby release, discharge and hold harmless Community Kinship Coalition Inc., its board members,
tournament officials, tournament organizers, tournament directors, the CKC Tournament committee and
members, other businesses, organizations and participants from all claims, demands, actions, judgments, and
executions which the signed names on the registration form ever had, now has, or may have or claim to have.
This includes all personal injuries, known and unknown and injuries to property, real or personal, caused by, or
arising out of the above-mentioned basketball tournament. I, the person(s) signing the waiver form have read
the above contents and understand all its terms. I execute it voluntarily and with full knowledge of its
significance.

Additionally I, the undersigned, do hereby release and hold harmless Community Kinship Coalition, Inc. from
any and all obligations and claims of any nature whatsoever, on my part or the part of my heirs or assigns, which
may arise now or in the future, from the use of any photographs, audio or video tape or film in which a likeness
or representation of myself shall appear or of my voice or a characterization in which I shall participate and
acknowledging that the use of said photograph, tapes and promotional material attendant thereto may be
edited and used at the absolute discretion of Community Kinship Coalition, Inc.. I certify that the applicant is
physically able to participate in the programs and activities of Community Kinship Coalition, Inc.

I attest the above information is correct to the best of my knowledge.

Authorized Representative:
Name:
Signature: Date:

“People Empowering People Towards Positive Change”