CYO BASKETBALL PARISH PERMISSION FORM
Name of Youth: ________________________________ Age: ______
Parish: _____________________________ Town: _______________
Parent/Guardian - Release and Consent Form
I, ___________________, the undersigned give permission for my son/daughter,
_____________________, to attend St Mary's Parish CYO Basketball 2012-2013 Archdiocese of Boston.
I give permission for my daughter/son to be transported in privately owned and/or public
vehicles to and from the events.
In case of medical emergency, I understand that every effort will be made to contact the parent(s) or
guardian(s) of my child. In the event that I cannot be reached, I give permission for my son/daughter to be
evaluated, diagnosed, treated, and/or medicated in accordance with standard medical practice by licensed
medical personnel. In addition, I give permission for the release of medical records to an attending
physician in case of illness. I relieve the Archdiocese of Boston, the League staff, and parish leaders of all
responsibility as a result of scheduling such treatment.
I hereby release the Roman Catholic Archdiocese of Boston, a corporation sole, its agents, servants, and
employees and all priests incardinated to the Roman Catholic Archdiocese of Boston, from any and all
liabilities for personal property incident to this event and any aforementioned medical care and treatment
which is provided. I will not hold the League staff, the Archdiocese of Boston, or the representatives
associated with the League program responsible in the event of injury.
My child agrees to abide by all the rules and regulations as outlined in the Leagueʼs Code of Behavior. I
understand that neither the League nor the Archdiocese of Boston will be held liable if my child fails to
cooperate with these regulations. I also realize that infractions of these rules may result in the immediate
dismissal from the League. I will be responsible for any costs or other requirements for immediate
transportation home.
Youth Participant Code of Behavior Commitment Form
As a member of the CYO Basketball Program, I understand and agree to abide by the League Code of Behavior. I also
understand and agree that I will notify my parents or guardian at the time of any infractions requiring my
dismissal from the League. In that circumstance, I understand and agree that I will be sent home at my own
or my parents' or my guardian's expense.
Signature of Youth Participant: _________________________ Date: ______
Signature of Parent or Guardian: ________________________ Date: ______