RELEASE FORM

Dear Parent/Guardian:

Your child _______________________________will participate in the Ozanam Basketball Program.  We (I) hereby release Ozanam/G.J.A., its directors, officers and volunteers, from any and all claims due to any injuries, harm, damages or losses from any source, whether related or unrelated to Ozanam/G.J.A., to my person and/or property foreseen, or unforeseen, patent or latent that could arise as a result of participation in the Ozanam Basketball League.  I have read this release and it is freely and voluntarily executed by me.  I do not rely on any inducements, promises, or representations made by Ozanam/G.J.A. or its agents or representatives.

Our (my) child, ________________________________ is covered by a personal insurance policy, or is included in my program.  I hereby authorize routine medical care for my child and I authorize treatment not considered routine to be referred to local physicians at my expense.

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Application, Parental Permission and Medical Form

Your Name_________________________________________________
Date of Birth _______________________________________________

School__________________________ Grade___ Ht .____Wt. _____

Home Address ____________________________________________
Phone__________________________________________

City/Town _______________________________ Zip Code __________

Parent/Guardian to contact in Case of Emergency

Name_______________________________________________________

Phone________________________ Cell Phone: ____________________

Team Name____________________________________ Age ________ Division___________________________________________

Coach Name _____________________________________Phone______________________

Assistant Coach ______________________________________Phone______________________

Students participating in Academic Team must show a 3.0 GPA and provide original report card.