MOA Mentor Waiver (version 1)
This waiver and release of liability form is intended to inform volunteer mentors of the potential risks associated with mentoring and officiating at youth basketball clinics, practices, games, and tournaments hosted by 127 SPORTS Intensity. Please read each section carefully and sign at the bottom to acknowledge and accept the terms outlined below.
1. Heads Up Concussion Awareness
In compliance with the Heads Up Concussion initiative, I acknowledge that I have received, read, and understand the signs and symptoms of concussions. As a mentor, I agree to promptly notify clinic staff if I suspect a concussion in any participant, and to stop play so the participant can be removed and evaluated. I agree to follow the same protocols if I suspect a concussion in myself. I understand that only a licensed healthcare professional can authorize the return to activity following a concussion.
2. Injury and Liability Waiver
I understand and acknowledge that mentoring and officiating youth basketball activities carries inherent risks of injury, including, but not limited to, collisions with players, sprains, fractures, dislocations, and head injuries. I voluntarily assume these risks. I hereby release, discharge, and hold harmless 127 SPORTS Intensity, its coaches, staff, volunteers, and affiliated parties from any claims, demands, or liabilities arising from injuries I sustain during any clinic or club-sponsored activities. This release covers all injuries or damages, whether they are physical, emotional, or mental, and whether resulting from negligence or other causes.
3. Health Insurance Responsibility
I understand that 127 SPORTS Intensity does not provide personal health or accident insurance for mentors. I affirm that I am responsible for my own health insurance coverage, and I assume full financial responsibility for any medical treatment I require as a result of my participation.
4. Video, Photography, and Publication Waiver
I grant permission to 127 SPORTS Intensity to capture my image, voice, and likeness through video, photography, or audio recordings during clinics, practices, games, tournaments, and other related activities. I understand these images and recordings may be used for promotional and training purposes, including but not limited to social media, club websites, printed materials, and media publications. I agree that I will not receive any compensation for the use of such media and waive any right to inspect or approve the materials where my likeness appears.
5. Medical Authorization and Emergency Contact
In the event that I am injured or become ill and am unable to make decisions for myself, I authorize 127 SPORTS Intensity staff to secure medical treatment on my behalf, including contacting emergency services or arranging transport to a medical facility. I agree to provide accurate emergency contact information, and I assume financial responsibility for any costs incurred as a result of emergency medical treatment.
6. Mentor Code of Conduct and Youth Protection
I acknowledge that I am expected to abide by the 127 SPORTS Intensity Code of Conduct, which promotes sportsmanship, respect for coaches, officials, players, and spectators, and adherence to club rules. Because I will be working with minors, I agree to conduct myself appropriately at all times, to interact with youth participants only in clinic settings and in view of other adults, to follow the directions of clinic staff, and to report any safety or conduct concern to clinic staff promptly. I understand that failure to comply may result in my removal from the clinic and from future mentoring opportunities.
7. Transportation Waiver
I understand that I am responsible for my own transportation to and from clinics, games, tournaments, and other activities. I assume all risks associated with that travel and release 127 SPORTS Intensity from liability for any incident or injury occurring during transportation. I agree not to transport any youth participant unless that participant's parent or guardian and clinic staff have approved it in advance.
Summary and Consent
By signing below, I confirm that I have read, understood, and agreed to each waiver section above. I recognize and accept the risks involved in mentoring and officiating youth basketball activities with 127 SPORTS Intensity, and I agree to the terms outlined above.
Acknowledgment of Entire Agreement
I certify that I am at least 18 years old, that I have read this waiver, understand its content, and agree to all terms as stated. I understand that this waiver represents the entire agreement between myself and 127 SPORTS Intensity, and no other verbal or written statements will alter its terms.
