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First name

Last name

Birthday

Month

Day

Year

Grade

Address

Mother's Name

Mother's Phone Number

Father's Name

Phone

Email

Relationship to Player

Medical Waiver and Release of Liability

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INspire MEmphis and any facilities where tryouts, practices, or games will be played will assume no responsibility for Injury or damages arising from the results of the above named Athlete's participation unless due to the willful misconduct or gross negligence on the part of One Glory Basketball, its affiliates or agents. Due to the strenuous nature of basketball, the Athlete participating and their parents are urged to consult their physician concerning the Athlete's fitness to participate.

Signature

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I hereby approve of the participation of my child, the above-named Athlete, in the One Glory Basketball Program. and consent to the emergency medical treatment for my child on my behalf. To the best of my knowledge, there are no physical or other conditions which will interfere with my child's participation.