EmailMe Form - BEST OF STUDENT SHOOTERS (B.O.S.S.) REGISTRATION

Date Time *

MM / DD / YYYY

Child/Participant's Name *

First Last

Phone *

### - ### - ####

Email

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Child's/Participant's Birth Date *

MM / DD / YYYY

Checkbox

Male

Female

About You! *

	Column2
School
Grade
Age
Height & Weight
Jersey Size Top/Bottom
Shoe Size

Parent/Guardian Information (N/A if it doesn't apply)

	First & Last Name	Phone	Email
Mother
Father
Guardian
Emergency Contact

Authorization Information and Waiver

Medical Consent / Transportation / Public Relations

1. I understand that every effort will be made to contact me in the event
of an emergency requiring medical attention for my child. However, if I
cannot be reached, I hereby authorize the staff/volunteers/assistants at the Best Of Student Shooters (B.O.S.S.) Youth League Fund, Inc. to transport my child to the nearest hospital or to treat my child when appropriate. *

Yes

No

2. I authorize that my child has a physical and copy of birth certificate and it is my responsibility to give it to the staff of the Best Of Student Shooters (B.O.S.S.) Youth League Fund, Inc. and make them aware of all medical issues concerning my child. *

Yes

No

List any medical, physical, or emotional conditions that we should be
aware of to better serve your child: (allergies, medication, etc.) or Child's Doctor and Type of Insurance

3.I give permission for my child to participate in field trips or be transported by means of bus/van/car, etc..
I understand that I will be notified in advance of any trips and it is MY RESPONSIBILITY to DROP my child off to events and to PICK my child up after ALL events and PRACTICES. Best Of Student Shooters (B.O.S.S.) Youth League Fund, Inc. is not responsible in transporting my child to or from all events or practices but only those that are put on by the organization during those times specifically specified. *

Yes

No

4. I give consent to have my child properly photographed/video taped/interviewed etc. for public relations and media purposes in Best Of Student Shooters (B.O.S.S.) Youth League Fund, Inc. programs and events. *

Yes

No

Are You Registering/Signing Up For *

WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT

PERMISSION AND RELEASE - READ CAREFULLY BEFORE SIGNING:
Realizing that there are risks inherent in any Best Of Student Shooters B.O.S.S. Youth League Fund Inc. program(s), and in consideration of my or our child/ward's being allowed to participate in this semester's Best Of Student Shooters B.O.S.S. Youth League Fund Inc.program(s), I/we agree to assume all risks (whether known or unknown) of participation in Best Of Student Shooters B.O.S.S. Youth League Fund Inc. program(s), to release and hold harmless BEST OF STUDENT SHOOTERS B.O.S.S. YOUTH LEAGUE FUND INC., SELMA CITY SCHOOLS, SELMA CITY SCHOOL BOARD OF EDUCATION, DALLAS COUNTY SCHOOL BOARD, PRIVATE SCHOOLS, together with its faculty, staff, employees, coaches, volunteers, trustees and other agents (collectively, the Releasees), from any and all claims, liabilities and damages relating to any injury, sickness, death or destruction of any property which may arise out of, result from or be in any way connected with the participation of my child/ward in Best Of Student Shooters B.O.S.S. Youth League Fund Inc. program(s), including transportation to/from related events or activities, other than claims, liabilities or damages based on the gross negligence of Best Of Student Shooters B.O.S.S. Youth League Fund Inc. or its employees. In addition, I/we agree to indemnify and hold the Releasees harmless from any and all claims for
injuries or property damage brought on behalf of myself or our child/ward or alleged to have been caused by me or by our child/ward while our child/ward is participating in Best Of Student Shooters B.O.S.S. Youth League Fund Inc. program(s).
I/WE HAVE READ THIS PARTICIPATION, ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY, AND INDEMNIFICATION AGREEMENT; FULLY UNDERSTAND ITS TERMS; UNDERSTAND THAT I/WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT; AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT (OTHER THAN THE OPPORTUNITY TO PARTICIPATE IN BEST OF STUDENT SHOOTERS B.O.S.S. YOUTH LEAGUE FUND INC PROGRAM(S)), ASSURANCE OR GUARANTEE BEING MADE TO ME/US. I/WE INTEND MY/OUR SIGNATURE(S) TO EFFECT A COMPLETE AND UNCONDITIONAL RELEASE AND WAIVER OF ALL LIABILITY, INCLUDING ANY NEGLIGENCE OF THE RELEASEES IDENTIFIED IN THIS AGREEMENT, AND TO INDEMNIFY THE RELEASEES, TO THE GREATEST EXTENT ALLOWED BY LAW.
I understand that Best Of Student Shooters B.O.S.S. Youth League Fund Inc. program(s), which may include practices, contests, competitions and/or related activities, may take place away from the main site of Best Of Student Shooters B.O.S.S. Youth League Fund Inc. Headquarters or prearranged facility. When program transportation is not available, I am responsible for either providing that transportation, allowing my child to
transport himself/herself to these activities, and/or allowing him/her to ride with another student or parent.
There are risks inherent in having my child/ward travel to and from Best Of Student Shooters B.O.S.S. Youth League Fund Inc. program(s) in vehicles driven by students (including my own child/ward), or parents, including without limitation the risks caused by weather and/or road conditions, the risks of inexperienced or negligent drivers, either in the vehicle in which my child/ward will be riding or in other vehicles on the road, and the risks of mechanical failure of vehicles. I agree to assume all such risks. By signing this waiver, for myself and on behalf of my heirs, assigns, personal representatives, next of kin, and marital community (if any), I HEREBY RELEASE AND HOLD HARMLESS BEST OF STUDENT SHOOTERS B.O.S.S. YOUTH LEAGUE FUND INC. AND ITS COACHES, EMPLOYEES, TRUSTEES, VOLUNTEERS, AND AGENTS (HEREINAFTER "RELEASEES") FROM ANY AND ALL LIABILITY CLAIMS, CAUSES OF ACTION, OR DEMANDS OF ANY KIND OR NATURE WHATSOEVER, AS WELL AS ANY AND ALL INJURY, DISABILITY, DEATH OR LOSS OR DAMAGE TO PERSON OR PROPERTY, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES, OR OTHERWISE, INCIDENT TO MY CHILD'S/WARD'S TRANSPORTATION OF OR BY ANY INDIVIDUAL IDENTIFIED IN THE PARAGRAPHS ABOVE TO ANY BEST OF STUDENT SHOOTERS B.O.S.S. YOUTH LEAGUE FUND INC PROGRAM(S) FOR THE CURRENT SEMESTER ENROLLED YEAR.

I have obtained the consent of any other parent or guardian with custodial rights affecting this Agreement Regarding Participation, Assumption of Risks, Waiver and Release of Liability and Indemnification and have the full legal authority
to enter into this Agreement on behalf of myself and such other parent or guardian.

I hereby further agree that this Waiver of Liability and
Hold Harmless Agreement shall be construed in accordance with the laws of the State of Alabama.

In signing, or checking yes to this release, I acknowledge and represent that I have read
the foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily; no oral representations,
statements, or inducements, apart from the foregoing
written agreement, have been made; I am at least eighteen (18)
years of age
and fully competent; and I execute this Release for full, adequate and complete consideration fully intending to be bound by the same.

Parent/Guardian’s signature required for individuals under eighteen (18) years of age.

CLICKING YES AND TYPING YOUR INITIALS SERVE AS YOUR OFFICIAL SIGNATURE IN FILLING OUT THIS WAIVER & APPLICATION. *

Yes

No

INITIALS *

Other Information

All information provided will remain confidential *** We would appreciate your filling out the following information as it helps us in our applications for United Way funds and state and federal government grant money for our programs. Thank you.

PAYMENT METHOD
Payment Method (Best Of Student Shooters BOSS Youth League Fund Inc.,
P.O. Box 233, SELMA, AL 36701

Due to our strict policies, we offer no refunds of registration, donations, fundraisers, or event participation. Do you understand this? *

Yes

No

By ENTERING your NAME you acknowledge all information is true to the best of your ability and agree with all terms and conditions. *

First Last

	Under $10,000	$10,001 - $20,000	$20,001 - $30,000	$30,001 - $40,000	$40,001 - $50,000	$51,001 - up
Annual Household Income

	Mother	Father	Grandmother	Grandfather	Other
Child Lives with