Basketball and Cheerleading Registration

Fairfield Baptist Church Recreation Ministry
2019-2020 Basketball and Cheerleader Registration

Child's Information


Parent Information


Medical and Emergency Information

If the answer is YES to any medical questions you MUST complete the additional MEDICAL FORM.


Waiver and Hold Harmless Agreement


As the parent or guardian of said child, I hereby give permission for my child to participate in the athletic program sponsored by the Micheal Benton Family Life Center, Inc. and the United Christian Athletic Association (UCAA). I understand that Micheal Benton Family Life Center, Inc., is a subsidiary of the Fairfield Baptist Church. The Micheal Benton Family Life Center, Inc. and the United Christian Athletic Association are non-profit charitable institutions, which are voluntarily presenting the basketball and cheerleader programs for my child, other participants, and the community. In consideration of giving my permission for my child to participate in the program this season (hereby called the (“COMPETITION”), which is organized by the Micheal Benton Family Life Center, Inc., and the United Christian Athletic Association, I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE, AND AGREE TO HOLD HARMLESS for any and all purposes the Micheal Benton Family Life Center, Inc., the Fairfield Baptist Church, the United Christian Athletic Association, and each and every organization involved with sponsoring the COMPETITION, and their officers, directors, agents, volunteers, or employees (hereby collectively called the (“ORGANIZERS”) FROM ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, DAMAGE TO PROPERTY, OR PERSONAL INJURY that may be sustained as a result of my child’s participation in the COMPETITION or the use of equipment or facilities provided by the ORGANIZERS. I also understand that my child is participating in an active sport, which can involve physical contact with other members, the floor, field, or equipment, and that there is a resulting risk of physical injury to my child. I have explained these risks and the benefits of participating in sports to my child and my child is in proper physical condition. My child does not have any existing injuries or conditions that could jeopardize his or her safety or health of the other participants.
My child’s participation in COMPETITION and its associated activities and events is completely voluntary at our own risk. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY that may be sustained during or as a result of his or her participation in the COMPETITION and its associated activities and events, WHETHER CAUSED BY AN ACT OF COMMISSION OR OMISSION on the part of the ORGANIZERS or otherwise. I FURTHER AGREE TO INDEMNIFY AND HOLD HARMLESS the ORGANIZERS for any loss, liability, damage or costs that may occur as a result of my child’s participation in the COMPETITION and its associated activities and events. It is my express intent that this CONVENANT NOT TO SUE AND HOLD HARMLESS agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased.In checking “YES” to this COVENANT NOT TO SUE and HOLD HARMLESS agreement, I acknowledge and represent that I have read the foregoing COVENANT NOT TO SUE and HOLD HARMLESS agreements, understands it, and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements apart from the foregoing agreement that has been reduced to writing have been made. I execute this document for full, adequate and complete consideration fully intending to be bound by the same, now and in the future.I/we the undersigned, being a parent or guardian of the minor listed above and having legal capacity to act on her behalf, do hereby consent to the foregoing HOLD HARMLESS AGREEMENT.

Payment