Amp 3on3 Referee Waiver
Total of 2 pages included. Every Section must be completely filled out to participate.
: Name: ________________________________ ________________________________ First LastAddress line 1: ___________________________________________________________ (Street (Apt #) / City / State / Zip Code)Address line 2: ___________________________________________________________ Date of Birth: ___________________ Age: ____ Gender: (Circle one) Male FemaleDD / MM /YY
Phone: ___________________________ E-mail: _______________________________ Shirt Size: (Circle One) Small Medium Large XL 2XL 3XL 4XL 5XL
Voluntary Waiver and Release Agreement
This Voluntary Waiver and Release Agreement (“Agreement”) is hereby executed by the undersigned, or if theundersigned is under the age of 18 years, then the undersigned’s parent or legal guardian (together with any heir,successor, representative or assign, collectively as “Participant”) in favor and for the sole and exclusive benefit of the Organizers (as defined herein). In connection with Participant’s involvement in a contest, promotional activityor in any other event which may take place at Celebration of Praise Church of God or Amplify Youth Ministries or Amp3on3 or which involves the use of Celebration of Praise Church of God or any of the facilities at theCelebration of Praise Church of God campus by Participant including, without limitation, a 3on3 basketballtournament and 3-point contest, Participant hereby certifies, warrants, represents, agrees and covenants toCelebration of Praise Church of God and Amplify Youth Ministries and any of the respective Event sponsors orpromoters, including, without limitation, all charities benefiting from the Event (individually and collectively,together with each of their respective affiliates, officers, employees, partners, members, board members,sponsors, volunteers, tenants, contractors, agents, successors and assigns, the “Organizers”), that he/she is:(1) FREE OF ANY MENTAL OR PHYSICAL CONDITION, AILMENT OR INJURY (MEDICAL OR OTHERWISE) WHICHWOULD, IN AND OF ITSELF OR IN CONJUNCTION WITH ANY OTHER CIRCUMSTANCE, INCLUDING BUT NOTLIMITED TO THOSE ACTIVITIES ASSOCIATED WITH THE EVENT, (i) IMPAIR, PREVENT OR PROHIBITPARTICIPANT FROM ENGAGING IN SUCH EVENT ACTIVITIES OR (ii) BE AFFECTED,
AGGRAVATED OR WORSEN IN ANY WAY AS A RESULT, DIRECTLY OR INDIRECTLY, OF PARTICIPANT’SINVOLVLEMENT IN SUCH EVENT;