2024 Winter Basketball Volunteer Registration & Release Form 2024 Winter Basketball Volunteer Registration & Release Form Please fill out this information to register for the upcoming basketball season! Email * First and Last Name: * Parent/Guardian name (IF UNDER 18) * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Age * Date of Birth * Example: January 7, 2019 Home/Cell phone Home Cell Parent/Guardian Phone Number (Home) (IF UNDER 18) * Parent/Guardian Phone Number (Cell) (IF UNDER 18) * Parent/Guardian email address (IF UNDER 18) * What dates will the volunteer participate in Basketball? Select as many as apply. * March 2 March 9 March 16 March 23 Check all that apply Preferred Communication * Publicity Release 2024 Basketball Player/Volunteer Registration & Release Form The Children's Center for Communication/Beverly School for the Deaf is a program that takes pride in using technological advances for educational purposes. These endeavors are often used to honor and promote the positive activities that occur on a daily basis. As part of standard practice, CCCBSD will use your child's image for internal media on a regular basis. CCCBSD defines internal media as photos/videos that can be viewed but are never shared externally as a hard copy or electronically (for example: photos in the classroom, classroom videos for shared experiences, photos/videos shown for events or presentations, etc.). Photos and videos are also used for purposes that require external media. CCCBSD defines external media as photos/videos that can be viewed and/or shared as a hard copy or electronically (e.g. Newspaper, annual reports, home notes, classroom photos emailed to families, YouTube, Facebook, etc.) CCCBSD will never post names of students to social media and websites. Only first names are given to newspapers. Parents will be notified if their child's likeness has been photographed for a newspaper article. If you have objections to your child being photographed or videoed for the purpose of external media please specify your objections below. (for example: All photos are fine. No video or All forms of media are okay but do not identify my child by name.) Do you have any exceptions you would like to specify for external media? YES NO Release Form I give my child permission to take part in the basketball program at CCCBSD. I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for disability, personal injury, or property damage for THE FOLLOWING ENTITIES OR PERSONS: The Children’s Center for Communication/ Beverly School for the Deaf and /or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that The Children’s Center for Communication/ Beverly School for the Deaf and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I hereby consent to medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. THIS WAIVER WILL BE EFFECTIVE FROM THE SIGNED DATE BELOW AND MOVING FORWARD. Release Form Agree * I assume all risks and hazards incidental to such participation in CCCBSD games and activities. I/we agree to be present at all games and activities so that I/we can manage our child's specific needs. I agree to be solely responsible for my child External Media Exceptions Please describe your external media exceptions here (i.e. all photos are fine, but no video, OR all forms of media are okay, but do not identify my child by name.) What external media exceptions should we be aware of? Emergency Contact Information Please fill out the following few questions to identify an emergency contact. Contact's name Contact's Phone Number Contact's Relationship to Family Electronic Signature or check box CCCBSD does not take responsibility for images taken of your child by non CCC BSD staff members that may be published as external media (e.g. a photo video with your child's image in the background at school-wide events.). Further, I release CCCBSD, its Board of Trustees, employees, and other representatives from any known liabilities, known or unknown, arising out of the use of these materials. I have read and fully understand all the above and hereby give my permission on all points from March 2, 2024 forward. While this permission form will be updated annually, it is understood that once external media is published it is impossible to guarantee that the material can be relinquished 100%. * I agree Signature/Parent/Guardian Electronic Signature (IF UNDER 18) signature keyboard Clear Date * Name Name First First Last Last If you are human, leave this field blank. Submit