Portland Pilots Basketball Game of Recognition and Inclusion

Waiver and Release of Liability

I represent and warrant that to the best of my knowledge and belief I am/my child is physically and mentally able to participate in Special Hoop Camp. I also represent that a licensed examiner has reviewed the health information set forth in my/the participant’s application and has certified, based on an independent medical examination, that there is no medical evidence which would preclude my/the participant’s participation. Special Hoop Camp has my permission (both during and any time after) to use my/the participant’s likeness, name, voice, or words in either television, radio, film, newspapers, magazines and other media in any form for the purpose of advertising or communicating the purposes and activities of Special Hoop Camp and/or applying for funds to support these purposes and activities. If a medical emergency should arise during my/participant’s participation in Special Hoop Camp activities at a time when I am not personally able/present to be consulted regarding my/participant’s care, I authorize Special Hoop Camp to take whatever measures are necessary to protect my/participant’s health and wellbeing, including, if necessary, hospitalization. I, the undersigned, have read and fully understand the provisions of the above release, and if I am an adult athlete someone has explained these provisions to me. By signing this release form I agree to the above provisions. If I am the parent/guardian of the athlete named on this form I am agreeing to the above provisions on my own behalf and on behalf of the athlete named on this application. If I am a witness for an adult athlete I certify that I have reviewed this release with the athlete and am satisfied that the athlete understands this release and has agreed to its terms.

At the NCAA basketball game,

• Hoop.Camp athletes and families will be recognized.
• 5 players will be announced with the starting line-up.
• 10 players will play a 5-minute game at half time.
• Some will be participants in the timeout events.

If you would like to participate in the starting lineup, play in the halftime game or participate in the time out activities, please contact Coach Garrity directly.

• Please DO NOT wear another teams’ clothing or hat to the game, as we are the host team's guests
• If you have been asked to participate in the game activities you MUST arrive and be in your seats 30 minutes prior to the start of the game. You will get detailed instructions.