Waiver:

I, _____________________, grant permission to Jeff Fuller to use any video or pictures of my child for promotion of jOURney.

I also waive and release all parties of any and all legal responsibility in the event of injury to my child. I assume all medical responsibility for my child’s participation in this basketball clinic.

Parent/Guardian:__________________________

Date: ___________________________________

Phone:__________________________________

Email:__________________________________

Insurance: _______________________________
_______________________________________