Informed Consent and Acknowledgement *

I hereby give my approval for my child’s participation in any and all activities prepared by the Alexandria-Fairfax (VA) Alumni Chapter of Kappa Alpha Psi Fraternity, Inc. In exchange for the acceptance of said child's candidacy by the Alexandria-Fairfax (VA) Alumni Chapter of Kappa Alpha Psi Fraternity, Inc. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Kappa Alpha Psi Fraternity, Inc. and all its respective officers agents and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from any Alexandria-Fairfax (VA) Alumni Chapter of Kappa Alpha Psi Fraternity, Inc. event. In case of injury to said child, I hereby waive all claims against Kappa Alpha Psi Fraternity, Inc. including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis or death.

Medical Release and Authorization *

As Parent and/or Guardian of the named applicant, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’ s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.Permission is also granted to the Alexandria-Fairfax (VA) alumni chapter of Kappa Alpha Psi, Inc. and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Photo Release *

I hereby give permission for my child to be photographed during their participation in the programs sponsored by the Alexandria-Fairfax (VA) Alumni Chapter of Kappa Alpha Psi, Inc. Fraternity. Inc. I understand the photos will be used to keep a journal of activities, to share during powerpoint presentations and/or reports to our donors and for promotional purposes including flyers, brochures, newspapers and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of Alexandria-Fairfax (VA) Alumni Chapter of Kappa Alpha Psi, Inc.