36~Elite Sports and Fitness Training

"Compete and Defeat"

Registration Forms

Minor Waiver/Release

RELEASE OF LIABILITY OF MINOR PARTICIPANTS

READ BEFORE SIGNING

IN CONSIDERATION OF _____________________________________ my minor child ("my child"), being allowed to participate in any way in the 36~Elite/Moves, program related events and activities, the undersigned acknowledges, appreciates, and agrees that:

1. The risk of injury to my child from the activities involved in this program does exist; and, FOR MYSLEF, SPOUSE, AND CHILD, I KNOWLINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, and assume full responsibility for my child’s participation; and,

2. I myself, my spouse, my child, and on behalf of my /our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE THE other participant, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct this program ("Releasees"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in this program, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

3.I, for myself, my spouse, my child, and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY INDEMINIFY AND HOLD HARMLESS all the above Releasees from and all liabilities incident to my involvement or participation in this program, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.

4. I give permission for the above named child to participate in the 36~Elite Moves program. I WILL ASSUME ALL RISKS AND HAZARDS that are incidental to the conduct of the activities. I AGREE TO RELEASE, ABSOLVE AND HOLD HARMLESS 36~Elite/Moves, MAULDIN PARKS AND RECREATION, CITY OF MAULDIN, AND ASSOCIATED CITY OF MAULDIN EMPLOYEES, and VENUSE USED OF ALL LEGAL RESPONSIBILITIES. I give permission to 36~Elite/Moves and 36~Elite/Moves associates to provide medical treatment in case of emergency or injury.

UNDERSTANDING OF RISK

I understand the risks involved in participating in this program, my personal responsibilities for adhering to rules and regulations, and accept them as a participant.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIOAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

_______________________________________ ______________________________________

(PARENT/GUARDIAN SIGNATURE) PRINT NAME

Insurance Waiver & Information

All athletes are required to provide proof of insurance. 36~Elite/Moves is not responsible or liable for any injures acquired during or resulting from training. By signing this waiver, you are assuming all medical responsibility for the following athlete(s).

Athlete Name __________________________________ DOB ___/___/______

Athlete Name __________________________________ DOB ___/___/______

Athlete Name __________________________________ DOB ___/___/______

Insurance Carrier ______________________________________________

Policy Number ________________________________________________

I have read and understand this waiver.

Parent Signature __________________________________________________

Print Name ______________________________________________________

In an effort to provide appropriate training for each athlete, it is highly recommended that all athletes get a physical examination before beginning this or any other exercise program.

36~Elite/Moves Registration Form 2014

Athlete Name_________________________________________________ Age _____

Parent(s) Name ________________________________________________________

Address _________________________________________

_________________________________________

Phone (cell) __________________________ (home) _______________________

Email address _________________________________________________________

Sports involved in _____________________________________________________

What are you interested in improving? _________________________________

_______________________________________________________________________

How many days a week are you able to train? ________

Circle days that work best: M T W Thur. *Fri *Sat* Su

(*Saturdays - Sundays will need to be scheduled before hand)

Do you have any physical conditions that would limit your full participation in any workout? ____________ If so, please explain __________________________

________________________________________________________ 

Contact Information:

Brandon Bennett (864)363-3603      [email protected]

Bralyn Bennett (803)361-2035    [email protected]

Ty Harrison (803)363-2794

                      36elite.webs.com         @36elite

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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