Child's First Name *

First Name

Last Name

Skill Level *

Beginner

Intermediate

Advanced

Parent/Guardian *

First Name

Last Name

Phone *

(###)

###

####

2nd Child's Name

First Name

Last Name

Date of Birth (DOB)

MM

DD

YYYY

Skill Level

Beginner

Intermediate

Advanced

KOPPS Basketball Liability & Consent Agreement *

Acknowledgment of Risk & Waiver of Liability I, the parent/guardian of the participant, acknowledge that participation in basketball involves physical activity and the risk of injury, including but not limited to sprains, fractures, concussions, or other serious harm. I understand that KOPPS, its coaches, volunteers, and affiliates will take reasonable precautions to ensure a safe environment but cannot eliminate all risks. By signing this agreement, I voluntarily assume full responsibility for my child’s participation and release KOPPS, its staff, volunteers, and partnering organizations from liability for injuries, accidents, or damages that may occur during practices, games, or related activities. Medical Authorization In the event of an injury or medical emergency, I authorize KOPPS staff and volunteers to seek appropriate medical care for my child. I accept financial responsibility for any medical treatment rendered. Photo & Media Release I grant permission for KOPPS to capture and use photographs, video, or audio recordings of my child during practices, games, or events for promotional, educational, and social media purposes. I understand that no personal compensation will be provided, and these images may be used to support KOPPS’ mission and community outreach. Parent & Spectator Code of Conduct KOPPS is committed to creating a safe, respectful, and positive environment for all participants and families. As a parent/guardian and spectator, I agree to: Demonstrate respect toward referees, coaches, players, volunteers, and other families. Refrain from using foul language, negative comments, or disruptive behavior during practices or games. Encourage good sportsmanship and support all players, not just my child. Accept that KOPPS reserves the right to remove any individual who does not adhere to these guidelines. Consent & Signature By signing below, I confirm that I have read and understand this Liability & Consent Agreement. I agree to abide by its terms and grant permission for my child to participate in the KOPPS Basketball Program.

Yes

No