Name:   Phone:   Relation:
    Name:   Phone:   Relation:

WAIVERS & TERMS:
By execution below, I hereby certify that the information above is true and correct. MEDICAL TREATMENT: In the event that my child requires emergency medical treatment and I cannot be reached, I hereby authorize the BCMUD Staff to make the necessary arrangements to transport my child to the nearest hospital/emergency facility.  I hereby give my consent for any and all medical treatment determined necessary by the treating physician. ASSUMPTION OF RISK: I acknowledge that BCMUD activities have inherent risk and by execution below, I assume all risk arising in connection with my participation, or my child's participation, in all such activities including transportation to and from activities.  LIABILITY RELEASE: On behalf of myself and my child, I agree to waive, hold harmless, release, and indemnify BCMUD, its employees, volunteers, officers, directors, contractors, participants, coaches, referees, as well as persons or parents transporting participants to and from such activities, from and against any and all claims, costs, expenses, liability, property damage, or personal injury arising out of or related to the use of BCCC facilities or participation in any BCMUD activity, whether located on BCCC property or not, by me or my child. RULES AND REGULATIONS - I agree that all participants, including me or my child, must comply with Brushy Creek MUD rules and regulations. All participants must comply with the Code of Conduct for players and coaches provided by the league office, and failure to do so may result in suspension or termination of participation rights. TEAM ASSIGNMENTS & REGISTRATION: I acknowledge and agree that BCMUD reserves the right to adjust, combine, separate and place participants in divisions for all leagues.  I acknowledge and accept that all friend and/or coaching requests may not be fulfilled.  Each player signs up as an individual, not as a group or team.  Once registration in a division is full, a waitlist will be formed.  TDFPS REGULATION: I agree that BCMUD's program is not regulated by the Texas Department of Family and Protective Services.   

I grant my permission for my child to participate in all water activities offered by BCMUD:
  Yes   No 

I grant my consent for pictures taken of my child to be used for future BCMUD promotions or display:
  Yes   No 

I grant permission for BCMUD staff to transport my child to and from the Community Center for Program related field trips and other planned events:
  Yes   No 

By signing below, I the Parent/Guardian, acknowledge that I have read and agree to the terms and conditions listed above.

Signature: Date:

Notes: