I, the parent/guardian listed below, in the event that my child is injured or should require medical attention, I hereby request you contact our family doctor. In the event the doctor can't be reached, I hereby authorize the coach, or any other program volunteer to secure necessary medical treatment for my cild. I further acknowledge that I will be responsible for any medical or hospital fees or costs associated with my child's medical treatment, which are not covered by insurance provided by the program. If possible, confirmation of the authorization should be made with me prior to treatment by calling me at the number listed below. In case I cannot be reached for an emergency, medical treatment as described above may proceed without further authorization. I assume all risks and hazards to such participation, including transportation to and from activities, and hereby waive, release, absolve, indemnify and agree to hold harmless the St. Louis Basketball Academy, the organizers, sponsors, supervisors, participants, and persons transporting my child to and from activities for any claim arising out of an injury to my child, whether the result of negligence or for any other cause, except to the extent, and in the amount covered by, accident or liability insurance. By completing this form, and typing my name in the field labeled, "Parent Signature," I agree to all conditions listed above in the Medical/Emergency Release Waiver. I also agree that my typed name in the field labeled, "Parent Signature" acts as my signature.
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