Name
of Participant (Printed): _________________________________________________________
In consideration of the above participant being allowed to participate
in any way in the athletic/sports program, related events and activities
sponsored by or associated with Saders, Inc. (Saders), the undersigned
acknowledges, appreciates and agrees that:
- The risk of injury from
the activities involved with this program is significant,
including the potential for permanent paralysis
and death, and while particular rules, equipment, and personal
discipline may reduce that risk, the risk of injury does
exist; and,
- I ACKNOWLEDGE AND FREELY
ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING
FROM THE NEGLIGENCE
OF RELEASEES
(which
includes, but is not limited to, Saders, Inc., its
board of directors, officers, coaches, officials, agents,
sponsors, advertisers, and
if applicable, owners, and lessors of premises use
to conduct
Saders events, which includes, athletic practices)
or others, and assume
full responsibility for the participant’s participation;
and,
- Participant is in good health and in proper physical
condition to participate in activities sponsored by
or associated
with Saders and hereby authorize any representative
of Saders
or medical provider,
to seek medical attention on behalf of participant,
to ensure participant’s
well being, without legal liability whatsoever, inclusive
of any responsibility for any negligent rescue or delayed
operations.
- Releases, waives, discharges,
and covenants not to sue Saders (as defined above including
Releasees), from
any and all liability
to each of the undersigned, their heirs
and the next of kin, for any and all claims, demands,
losses or
damages on account
of any
injury, including death or damage to property,
caused or
alleged to have been caused, in whole or
in
part, by the Releasees or otherwise.
- I hereby authorize Saders
to utilize in any promotional materials any photograph taken
of me, or
my child, while participating in
any activity sponsored by or associated
with Saders.
I/WE HAVE READ THE ABOVE AGREEMENT AN UNDERSTAND THAT I/WE GIVE
UP CERTAIN RIGHTS BY VOLUNTARILY SIGNING IT, AND SIGN IT FREELY
AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Address
_________________________________ City, State, Zip __________________________
Child's
Grade ________ School ________________________________ Birthdate
______________
Contact
Phone Number #1 ________________________ Contact #2
________________________
Contact
Email Address #1 ________________________ Email #2 __________________________
Emergency
Contact Name ________________________________________________________
Emergency
Contact Phone Number ________________________________________________
Printed
name of Parent or Guardian _________________________________________________
Signature
of Parent or Guardian ____________________________________________________
Relationship
to Participant ________________________________________________________
Date
Signed __________________________
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