Medical release forms
December 16, 2011I just recieved an email for competition We need to bring waiver forms with us tomorrow. YOu can highlight and print a form and bring it tomorrow I can also bring extra copies with me.
Medical Release form
I am the parent or legal guardians of the child identified below and voluntarily authorize my child to participate in the Cheerleading Competition at Central Valley High School. I understand that there are inherit dangers associated with gymnastics, cheerleading and dance and recognize that any physical activity involves risks of serious injury or death, including but not limited to temporary or permanent muscular and skeletal injury and paralysis.
I assume all risks, whether foreseen or unforeseen, in connection with my child participation in this activity.
I AGREE TO DEFEND, INDEMNIFY, HOLD HARMLESS, WAIVE, AND RELEASE BUILD IT ATHLETIX LLC AND CENTRAL VALLEY HIGH SCHOOL, TOGETHER WITH ITS OFFICERS, TRUSTEES, EMPLOYEES, AGENTS AND MEMBERS, AGAINST ANY AND ALL LIABILITY, CLAIMS AND CAUSES OF ACTION ARISING OUT OF, OR IN ANY WAY CONNECTED WITH MY CHILD’S PARTICATION IN THIS ACTIVITY.
Athlete’s Name: ______________________
Parent’s Name: ______________________ Parent’s Signature: __________________________
Athlete’s Doctor: ____________________________________________ Phone Number: _________________
Insurance Company: _________________________________________ Policy Number: __________________
Medication Currently Taking: _________________________________________________________________
Allergies to medications: _____________________________________________________________________
Further medical information, special needs and disabilities: _________________________________________ _________________________________________________________________________________________
Appearance Clause
I understand that promotional material may be produced using photos and videos from this competition. I understand that as a participant I may be included in videotape or photographs taken during observation, instruction, classes, practices, performances and/or competitions. I hereby grant Build It Athletix LLC, and Central Valley High School, its successors, assignees, licensees, sponsors, any television networks, and all other commercial exhibitors, the exclusive right to photograph and/or videotape the participant and further utilize participants face, likeness, voice and/or appearance as part of the program in advertising, marketing and promoting the program without reserve or limitation. In granting this license, I undersign that Build It Athletix LLC and Central Valley High School are under no obligation to exercise any of its rights, licenses and privileges herein granted by the participant.
Please initial blanks:
_____ I understand that any formal or informal team photo may be placed on the website for informational/promotional purposes anytime during the year.
_____ I understand that casual action photographs may be taken during observation, instruction, classes, practices, performances and/or competitions.
Posted by Sarah Story