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PREMIER INDOOR ATHLETICS, LLC Approval to Participate / Facility and Equipment Use / Acknowledge of Risk / Waiver and Release of Liability / Consent for Medical Treatment ________________________ ____________________ ____________ Player’s Last Name First Name Birth Date Approval to Participate I, the undersigned, a parent/legal guardian of the above-named player, a minor, or, as a player over the age of 18, hereby give my permission and consent for said player to participate in any and all activities at Premier Indoor Athletics (“Premier” or “Company”), including transportation to and from such activities. Waiver and Release of Liability In consideration of my use of the Premier Indoor Athletics equipment and facilities, I hereby forever release and covenant not-to-sue Premier Indoor Athletics, LLC, its owners, members, officers, trainers, employees, customers, clients and agents, for any physical injury or harm or death or damage to property arising as a result of my participation in or incidental to said athletic activities, however the same may occur. I hereby also voluntarily waive any and all claims both present and future, resulting from ordinary negligence, that may be made by me, my family, estate, heirs, estate or assigns, and I relinquish on behalf of myself, spouse, heirs and assigns the right to recover for injury or death. I understand that this waiver is intended to be as broad and inclusive as permitted by the laws of the State of Utah, and I agree that if any portion is held invalid, the remainder of the waiver will continue in full legal force and effect. Acknowledgement of and Assumption of Risk / Personal Insurance I acknowledge that the participation in competitive and contact sports is an inherently dangerous activity and that such activity is vigorous and can involve severe cardiovascular stress and other stress to other parts of the body. I understand that sports and fitness activities involve certain risks, including, but not limited to, injury and death. In addition, I acknowledge that participation in physical activities and training (including use of facilities and training equipment) and activities incidental thereto, includes, but is not limited to, the possible reckless conduct of other participants. All stresses and hazards associated with these activities cannot be foreseen. I agree to voluntarily assume any and all risks associated with the use the athletic training facilities and equipment with full knowledge of the danger involved and hereby agree to accept any and all risks of property damage, personal injury, or death. I have a personal responsibility to follow any safety rules and procedures established by the Company and those associated normally with sports training and other activities. Indemnification I further agree to indemnify and hold harmless the Company and others listed for any and all claims arising as a result of my participation in the sports activities or any activities incidental thereto, wherever, whenever, or however the same may occur. I further agree that the venue and jurisdiction for any legal proceedings shall be in the State of Utah. Consent to Medical Treatment I authorize the Company or its representatives, as agent to the undersigned, to give consent for emergency medical care prescribed as deemed advisable by a duly licensed Doctor of Medicine or Doctor of Dentistry or emergency Medical Technician. This care may be given under whatever conditions are necessary to preserve the life, limb or well being of myself or my dependent player, as appropriate. This authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of my agent to give specific consent to any and all diagnosis, treatment or hospital care which the physician in the exercise of his best judgment may deem advisable. This authorization is given will be applied to emergency care only, and shall remain effective until revoked in writing. I also agree to carry personal or family health insurance coverage and agree that any such insurance shall be primary in the event of an accident or injury. If I am at least 18 years of age, I affirm that I am signing this agreement freely and without duress. If I am under 18 years of age, I will also obtain the signature of my parent or guardian. I have read this form and fully understand that by signing this form, I am giving up legal rights and/or remedies which may be available to me for the ordinary negligence of the Company or any of the parties listed above. I understand that this agreement is a binding legal document. For persons under the age of 18, the parent or guardian who signs below also commits to the participant the conditions of this agreement. CAUTION: READ THIS DOCUMENT CAREFULLY BEFORE SIGNING: _______________________________________ __________________ Printed Name of Participant Date Signed _______________________________________ __________________________________________ Signature of Participant Signature of Parent/Guardian if Participant is a minor _______________________________________ _________________ _____ ______________ Home Address City State Zip Code ______________________________________________________________________________________ Email Address ____________________________________ ________________ __________ ______ Phone Number Team Name Gender Age 12/09 |
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