Child’s Name

Address

Playing Experience (Last 2 seasons)

Medical Problems/Limitations/Allergies

Parent/Guardian Contact Information

Parent/Guardian’s Name(s)

Emergency Contact

COVID-19 Waiver

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID-19 can cause serious and potentially life-threatening illness and even death. 

DST Basketball, LLC cannot prevent you or your child from becoming exposed to, contracting, or spreading COVID-19 while utilizing DST Basketball, LLC’s services or premises. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize DST Basketball LLC’s services and/or enter onto DST Basketball, LLC’s premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19. 

ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize DST Basketball, LLC’s services and enter DST Basketball, LLC’s premises. These services are of such value to me and my child that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize DST Basketball, LLC’s services and premises in person. 

ASSUMPTION OF RISK: I hereby forever release and waive my right to bring suit against DST Basketball, LLC and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing DST Basketball LLC’s services and/or premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen. 

CHOICE OF LAW: I understand and agree that the law of the State of New Jersey will apply to this contract. 

I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE

As the parent/guardian of the child named above, I hereby give my full consent and approval for my child to participate in any activity of DST Basketball, LLC which may include Tryouts, Practices, Clinics, Camps, and/or Basketball Games. I also waive, release and hold harmless Coach Ken Ferrare and any staff member(s) of DST Basketball, LLC, and/or any facility DST Basketball, LLC utilizes, for any injury that the child may suffer while in the course of participating in any activity including but not limited to travel to an event. By signing this waiver, I also give permission for DST Basketball, LLC to photograph any activity to promote DST Basketball, LLC in Social Media, Media Publications, or Company Literature. I am the parent or legal guardian of the minor named above. I have the legal right to consent to and, by signing below, I hereby do consent to the terms and conditions of this Release.

Parent's Signature

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