I am aware that basketball is a strenous sport and that participation in basketball games, training, and conditioning can result in physical injuries, such as sprains, broken bones, head injuries, etc.. I am fully familiar with my child's medical and physical condition. My child has no illness or other medical condition which prevents him or her participating in a vigorous sport such as basketball or which would be aggravated or exacerbated by or otherwise result in a worsening of my child's medical or physical condition due to his or her participation in basketball games, training or conditioning. I understand that Pasadena Japanese Athletic Association (PJAA) / Pasadena Bruins and the coaches, assistant coaches, parents, and other team members acting in such capacities or in the capacity of activity supervisors will rely on the foregoing representations. For and in consideration of my child being permitted to participate in PJAA, Japanese Optimist Organization (JAO), Community Youth Counci (CYC) and its affiliated organizations, and in their basketball games, training, and conditioning, I, the undersigned parent or guardian, hereby voluntarily waive, release, and discharge and relinquish for myself and my family, including my child, our heirs, successors and assignees, any and all liability, claims, suits, actions, or causes of actions against the Pasadena Buddhist Templ, PJAA, Pasadena Japanese Cultural Institute (PJCI), their respective officers, agents, and the coaches, assistant coaches, parents, and other team members, for personal injury, death, or property damage occurring to my child arising from my child's participation therein and in any activity incidental thereto wherever or however the same may occur, and whether the same may arise from the negligent acts or omissions of any of said persons, or otherwise.

If it becomes necessary for my child to have medical, surgical, or dental are while participating in any of the aforementioned activities, I hereby authorize the coaches, assistant coaches, parents, or team members, acting in such capacities or as activity supervisors, as my agents to consent to medical, surgical, or dental examination and treatment. In case of such emergency, I hereby authorize treatment and care by any physician at any hospital.