THE ACADEMY

WAIVER OF LIABILITY AND DISCLAIMER (LIFETIME AGREEMENT)

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Team Name (If Applicable)textoptionaldb save

Child(s)

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I/we (parents or guardian if applicable) hereby give my/our consent and agree to release, indemnify and hold harmless THE ACADEMY, and all personnel, including officials, staff, representatives and owners, from any claim arising out of any injury to the named individual(s). I understand the hardness of the playing surfaces and dasher boards, the different & unique characteristics of artificial turf (as opposed to grass), hardwood and gym matting and the roughness of sport and activities. I acknowledge the pool and take all necessary safety measures when in and/or around all pool spaces. I grant THE ACADEMY the right to photograph or video all participants/viewers in activities and to use the photographs or video in future brochures, commercials, or social media.

GUARANTEE OF COMPLIANCE TO RULES OF THE ACADEMY

In the event of any dispute arising between the undersigned and THE ACADEMY, the undersigned agrees to comply with all of THE ACADEMY rules and policies and allows THE ACADEMY to impose restrictions and/or penalties as a result of noncompliance in the office of THE ACADEMY (10300 S. Redwood Rd. South Jordan, UT 84095).

EMERGENCY AUTHORIZATION

I/we the undersigned, parents or guardian of all participant(s), do hereby authorize the coaches, assistants, staff, or parents of team members acting in the capacity of activity supervisors. As agents for the undersigned do hereby consent to medical, surgical or dental examination or treatment, etc. In case of emergency, I/we hereby authorize treatment and/or care of registered participant(s) in ANY hospital and by any medical physician. If there is an emergency and I/we can not be reached, please contact:

Emergency Contact Nametextrequireddb save
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Your Family Doctortextoptionaldb save
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WHAT ACTIVITIES ARE YOU HERE FOR AND/OR ARE INTERESTED IN? (select all that apply)

Team Rental
Kids Club
Swimming Lessons
Birthday Party
Soccer
Swim Team
Family Night
Basketball
Open Swim
Other
If Other, please specifytextoptionaldb save

AUTHORIZATION OF EMERGENCY CARE, ACKNOWLEDGEMENT OF DISCLAIMER, AND GUARANTEE OF COMPLIANCE TO RULES OF THE ACADEMY

Date: 1/20/2022

Time: 8:08 PM

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Parent/Legal Guardian (if player is 17 or younger)

Parent/Legal Guardian Nametextoptionalnot save
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Parent/Legal Guardian Signatureoptionalnot save
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Date: 1/20/2022

Time: 8:08 PM

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Submission Sequence: 2022-02-19T20:10:04.206Z3
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