Referee Application

Name *

Address *

Country

City

Zip code

Phone *

Email *

Gender *

Male

Female

Have you ever been involved with any other youth program? If so, please list below. *

Have you ever been accused or convicted of a felony? If yes, please provide details. *

Have you ever been registered for any offense under 290 C.P.C, sexual offender registration (or equivalent penal code in your state)? If yes, please explain and give date. *

Have you, to your knowledge, ever had any complaints against you regarding your behavior? If yes, please explain and give date. *

Can you maintain an even temperament during a moment of trial? *

Yes

Background Check *

I will complete a background check when requested.

I agree

Liability Waiver *

In consideration of being allowed to participate in any way in Cupertino Hoops program, related events and activities, I acknowledge, appreciate, and agree that:
1) The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
2) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,
3) I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest board member immediately; and,
4) I HEREBY RELEASE AND HOLD HARMLESS Cupertino Hoops, their directors, officials, volunteers, other participants, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I agree

Liability Waiver for Minors *

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF APPLICATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.

I agree

Sudden Cardiac Arrest Training *

I have completed the NFHS Sudden Cardiac Arrest Training

Yes

Concussion Training *

I have completed the NFHS Concussion Training

Yes

PLEASE PRESS THE SUBMIT BUTTON TO COMPLETE YOUR APPLICATION