Relay for Life Team 4Love and 4Life 3 on 3 Basketball Tournament Media & Health Release Form

Media Statement I, the undersigned, hereby consent and agree that Relay team 4Love and 4Life, Preble County, National Trail Local School, employees of, or agents have the right to take photographs, videotape, or digital recordings of me during the 3 on 3 Basketball Tournament, Saturday April 13, 2013. I consent to the use of these in any and all media, now or hereafter known, and exclusively for the purpose of promoting the tournament. I further consent that my name and identity may be revealed therein or by descriptive test or commentary. I do hereby release to Team 4Love and 4Life, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market and sell all copies. I waive any rights, claims, or interests I may have to control the use of my identity or likeness in whatever media used to promote the tournament. I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback. Health Statement and Release of Liability I know that participating in a basketball tournament is a potentially hazardous activity and I should not compete unless I am medically fit and properly trained. I agree to abide by any decision of tournament officials relative to my ability to safely compete. I assume all risks associated with participating in this event including but not limited to: falls, contact with other participants, high heat and/or humidity, bruises, scrapes, and loss of ego, all such risks being known and appreciated by me. Having read this waiver and knowing these facts, I myself and anyone entitled to act on my behalf, waive and release Team 4Love and 4Life, all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation in this event, though that liability may arise out of negligence or carelessness on the part of the persons names on this waiver. I represent that I have read and understand that foregoing statement and am competent to execute this agreement.

Name__________________________________________________________________Date____________________ Address________________________________________________________________________________________ Phone_____________________________________Email________________________________________________ In case of emergency contact_________________________Phone____________________Relationship___________ Signature________________________________________________________ Witness________________________________________________________