Participant’s Name: _______________________

Date of Birth: _________________________

Name of their School: _____________________

I, the parent/guardian of the Participant named above, hereby give permission for my child to participate in the activities of TheyCare Foundation which include playing basketball. I understand that my child will be obligated to attend regularly scheduled practices and competitions as part of their involvement in the program.

I understand that my child is responsible for his/her behavior at all time, and agree not to hold TheyCare or any of its employees responsible for any expenses or damages incurred as a result of my child’s behavior.

I understand that TheyCare may take photographs and videos of my child. I hereby grant permission to TheyCare to use photographs of my child in publications, for advertisements and in other communication related to the mission of TheyCare.

I understand that it is necessary for my child to have an approved medical certificate before participating in the activities of TheyCare. I agree to inform TheyCare of any changes in my child’s medical or physical condition which develops or is discovered at any time after the date this document is signed.

I agree that in the event of injury or illness, TheyCare employees may act in my behalf and at my expense in obtaining medical treatment for my child.

I realized that the primary insurance coverage, if any injury should occur, would be my responsibility.

In an emergency. Please contact me at ______________ or _________________

Print name of the Parent _______________________ Signature ______________ Date______________________

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