Athlete Release Form - CA Pride Allstars

Athlete Information

Athlete Name

First Last

Birthdate*

Sex*

Phone*

Email*

How did you hear about us?*

I was referred by:

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Medical Background

Do you have any medical concerns or medications being taken we should know about? (Back, shoulder, knee problems, etc.?)*

Emergency Contact Information

Emergency Contact #1 Name*

Parent/Legal Guardian

First Last

Relationship to Athlete*

Cell Phone*

Work/Home/Alternate Phone*

Emergency Contact #2 Name*

Parent/Legal Guardian

First Last

Relationship to Athlete*

Cell Phone*

Work/Home/Alternate Phone*

Insurance Information

If medical coverage changes after this document has been accepted it is your responsibility to inform CALIFORNIA PRIDE ALL-STARS STAFF as soon as possible.

Insurance Carrier*

Policy Number*

Doctor's Name*

Doctor's Phone Number*

Consent

Physical Activity*

CLIENT/ATHLETE ACKNOWLEDGES THE SERVICES PROVIDED BY CALIFORNIA PRIDE ALL-STARS INVOLVE PHYSICAL ACTIVITIES CARRY INHERENT RISKS OF PHYSICAL INJURIES OR OTHER DAMAGES, INCLUDING, BUT NOT LIMITED TO, HEART ATTACKS, MUSCLE STRAINS, PULLS OR TEARS, BROKEN BONES, SHIN SPLINTS, HEART PROSTRATION, KNEE/LOWER BACK/FOOT INJURIES AND ANY OTHER ILLNESS, SORENESS, OR INJURY HOWEVER CAUSED, OCCURRING DURING OR AFTER PARTICIPANT PARTICIPATION IN THE PHYSICAL ACTIVITIES.

Risk of Injury*

CLIENT/ATHLETE FURTHER ACKNOWLEDGES THAT SUCH RISKS INCLUDE, BUT ARE NOT LIMITED TO, INJURIES CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR/COACH OR OTHER PERSON, DEFECTIVE OR IMPROPERLY USED EQUIPMENT, OVER-EXERTION OF A MEMBER, SLIP AND FALL BY MEMBER, OR AN UNKNOWN HEALTH PROBLEM OF CLIENT/ATHLETE.

Professional Help*

CLIENT/ATHLETE ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY CHALLENGING, AND CLIENT/ATHLETE AGREES THAT IT IS THE RESPONSIBILITY OF CLIENT/ATHLETE TO SEEK COMPETENT MEDICAL OR OTHER PROFESSIONAL ADVICE, REGARDING ANY CONCERNS OR QUESTIONS INVOLVED WITH THE ABILITY OF CLIENT/ATHLETE TO TAKE PART IN THE PHYSICAL Do you have any medical concerns or medications being taken we should know about? (Back, shoulder, knee problems, etc....?) THIS IS PAGE 2 OF 2 (TURN OVER PAGE) ACTIVITIES OFFERED BY CALIFORNIA PRIDE ALL-STARS.

Treatment Release*

I AUTHORIZE ANY LICENSED PHYSICIAN TO RENDER NECESSARY EMERGENCY TREATMENT FOR INJURY OR SERIOUS ILLNESS WHEN NEITHER PARENT CAN BE REACHED AND WILL ASSUME ALL FINANCIAL RESPONSIBILITY FOR SUCH TREATMENT.

Insurance*

I ACKNOWLEDGE THAT THE ABOVE MENTIONED CLIENT/ATHLETE MUST HAVE HIS/HER OWN MEDICAL/ACCIDENT INSURANCE.

Publicity Release*

THE UNDERSIGNED DOES HEREBY GRANT CALIFORNIA PRIDE ALL-STARS TO PRODUCE PROMOTIONAL MATERIAL RELATING TO ITS PROGRAMS, I UNDERSTAND THAT AS A PARTICIPANT AND/OR A SPECTATOR THAT THIS MAY INCLUDE VIDEOTAPES OR PHOTOGRAPHS TAKEN DURING THE COURSE OF MY TEAM MEMBERSHIP. THEREFORE WITHOUT RESERVATION AND LIMITATIONS, I, IN MY OWN BEHALF AND/OR ON BEHALF OF MINOR, HEREBY ASSIGN, TRANSFER AND GRANT CALIFORNIA PRIDE ALL-STARS, IT’S SUCCESSORS, ASSIGNEES, LICENSEES, SPONSORS, AND ALL OTHER COMMERCIAL EXHIBITORS THE EXCLUSIVE RIGHT TO PHOTOGRAPH AND /OR VIDEOTAPE MINOR AND TO UTILIZE SUCH VIDEOTAPES, PHOTOGRAPHS, MINOR’S NAME, FACE LIKENESS, VOICE AND APPEARANCE AS A PART OF AN EVENT, IN THE ADVERTISING AND PROMOTING AND EVENT OR IN ADVERTISING AND PROMOTING SIMILAR FUTURE EVENTS OR ADVERTISEMENTS. I FURTHER UNDERSTAND THAT NEITHER CALIFORNIA PRIDE ALL-STARS NOR ANY THIRD PARTY IS UNDER ANY OBLIGATION TO EXERCISE ANY OF THE FOREGOING RIGHTS, LICENSES, OR PRIVILEGES.

Athlete Signature

Client/Athlete Signature*

Date*

Parent Signature

Parent/Guardian Consent*

I HAVE READ THE CLIENT/ATHLETE AGREEMENT AND UNDERSTAND THE INHERENT RISKS ASSOCIATED WITH A TRAINING PROGRAM. I CONSENT TO ALLOW MY SON/DAUGHTER TO PARTICIPATE IN THE ACTIVITIES DESCRIBED HEREIN AND REQUESTED FROM CALIFORNIA PRIDE ALL- STARS.

Parent Name*

First Last

Parent Signature*

Date*

Waiver of Liability, Indemnity Agreement, and Assumption of Risk

THIS IS AN IMPORTANT LEGAL FORM. IT WAIVES AND LIMITS YOUR RIGHT TO SUE CALIFORNIA PRIDE ALL-STARS AND ITS OWNERS, AGENTS, EMPLOYEES, SUCCESSORS, AND ASSIGNS FOR INJURIES TO YOU (OR YOUR CHILD) RESULTING FROM THE NEGLIGENCE OF CALIFORNIA PRIDE ALL-STARS. PLEASE READ AND MAKE SURE YOU UNDERSTAND THAT YOU ARE GIVING UP IMPORTANT LEGAL RIGHTS.

1. Definitions.
A. Activity. The word “Activity” as used in this Agreement means training for and participation in competitive cheerleading and all activities necessary thereto, including but not limited to, use of the cheer gym, use of Company facilities, use of Company equipment, use of recommended equipment, classes, organized activities, instruction, observation, related activities in a non-supervised setting, traveling to and from competitions and events, and other team activities.
B. Company. The word “Company” as used in this Agreement means California Pride All-Stars, Inc., and its owners, shareholders, directors, officers, employees, agents, successors, and assigns.
C. I/Me/My. The use of the pronouns “I” and/or “Me” and/or “My” shall refer to the person signing this Agreement, and his or her heirs, personal representatives, and assigns. In the case of a parent/guardian signing on behalf of a minor child, the words “I” and/or “Me” and/or “My” shall be interpreted to include the minor child.

2. Waiver.
In exchange for being permitted to participate in Company’s activities, events and programs including any associated use of the premises, facilities, staff, equipment, transportation, and services of Company I, hereby release, waive, discharge, and promise not to sue the Company from/regarding any and all claims, including the negligence of the Company or the negligence of third party participants in the Activity resulting in:

A.*

Personal injury (including death, accidents or illnesses) arising directly or indirectly from participation in the Activities directed, suggested, or planned by the Company; and to

B.*

Property damage, including any and all claims resulting from/in the damage to or loss of, or theft of My personal property; and to

C.*

COVID-19, including the spread, sickness, injury, and complications from COVID-19.

3. Assumption of the Risk.

*

Fitness and conditioning activities, by their very nature, carry with them certain inherent risks that cannot be eliminated regardless of the care that the coach/trainer takes to prevent injuries. The coaching/personal training activities offered by the Company include weight lifting, walking, jogging, running, stretching, and other aerobic activities. Some of the Activities involve strenuous exertions of strength using multiple muscle groups. Some involve quick movements involving speed and change of direction. Others involve sustained physical activity that places strain on the cardiovascular system.

*

I am aware that the coach/trainer may push Me (or My child) up to and beyond My (or My child’s) physical limitations to make Me (or My child) stronger. I am aware of the inherent risks of injury, death, and property damage involved in the Activity, including without limitation to muscle strains, muscle pulls, muscle tears, broken bones, torn ligaments, shin splints, heart prostration, death, paralysis, knee/lower back/foot injuries, lost or destroyed property, concussions, heart attack, stroke, and other forms of injury common to competitive athletic sports and gymnastics. I am also aware of the risks of injury, death, and property damage that may result from the active or passive negligence of the Company, including without limitation, the risk of negligent supervision or instruction.

*

Additionally, many of the Activities will involve equipment (e.g., spring floor, barbells, dumbbells, kettlebells, and other free weights) and complex machines (e.g., trampoline tumble tracks), which all have the potential to malfunction, be used improperly by a third party, Me (or My Child), or cause injury.

*

I (or My child) consents to be pushed beyond My physical limitations by the Company’s coaches and/or trainers and understand the risk inherent in this Activity.

*

Additionally, I am aware that training and competing with other athletes may expose Me (or My child) to the risk of sickness, including COVID-19.

*

With full knowledge of these risks and damagers, I (or My child) freely and voluntarily chooses to engage in the Activity and assume(s) any known and unknown risks of injury, sickness, death, or property damage that may result from the Activity.

3. Release of Liability.

*

I release the Company from any liability to Me (or My child) for all liability, claims, damages, or demands for personal injury death, or property damage, arising from or related to this Agreement or to the Activity. This release includes, without limitation, any personal injury, death, sickness, or property damage caused by the active or passive negligence on the Company. I understand that I bear sole responsibility for any loss.

*

In addition, I further release Company from any known or unknown claims and waive my rights under Section 1542 of the California Civil Code, which says:

A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.

4. Indemnification and Hold Harmless.

*

I also agree to indemnify, defend, and hold Company harmless from any and all claims, actions, suits, procedures, costs, expenses, damages, and liabilities, including attorney’s fees, arising out of or related to, My (or My child’s) participation in the Activities or use of Company facilities. I agree to reimburse the Company for any and all expenses the Company may incur as a result of My (or My child’s) involvement in the Activities or use of the Company’s facilities or equipment, including court costs, attorney’s fees, damages, and costs investigating any and all claims and lawsuits arising from or related to My (or My child’s) participation in the Activity.

5. Severability.

*

I intend that the interpretation of this Waiver and Release of Liability, Assumption of the Risk, and Indemnification Agreement is interpreted in the broadest and most inclusive manner possible as permitted under California law. If any portion of this Agreement is found to be invalid or unenforceable, then the remaining portions may continue in full force and effect.

6. Governing Law and Jurisdiction.

*

This Agreement shall be interpreted under California law and any disputes arising out of this Agreement or in connection with the Activity shall be made in the California State Courts.

7. COVID-19 Disclosure.

*

I understand that COVID-19 poses a serious health risk. The CDC recommends that persons wash their hands frequently and practice social distancing. I understand that it is my responsibility to control the surfaces and people with which/whom I come in contact. I also understand that I must abide by the Company’s policies for gym activity and must not engage in the Activity if I have symptoms of COVID-19, including but not limited to, a fever, breathing problems, and other “flu-like” symptoms. I understand that coming into contact with surfaces and people outside my home exposes me to the risk of spreading or becoming infected with COVID-19.

8. Counterpart.

*

This Agreement will be executed in counterpart copies it is agreed that each counterpart shall be deemed an original.

Final Consent*

I acknowledge that I have carefully read this Agreement, understand its contents, and understand that this Agreement includes an assumption of the risk of the Company’s negligence and a release of the Company’s liability. I understand that if anyone sues the Company for my own negligent acts arising from or related to the Activity, I must defend the Company at my own cost or pay for the Company’s damages. I also ACKNOWLEDGE THE RISK OF COVID-19 (and other risks of injury) and choose to engage in the Activity anyway. I understand that I am giving up SUBSTANTIAL RIGHTS, including the right to sue the Company.

Athlete Signature

Client/Athlete Signature*

Date*

Parent Signature

Parent Name*

First Last

Parent/Guardian Consent*

I HAVE READ THE CLIENT/ATHLETE AGREEMENT AND UNDERSTAND THE INHERENT RISKS ASSOCIATED WITH A TRAINING PROGRAM. I CONSENT TO ALLOW MY SON/DAUGHTER TO PARTICIPATE IN THE ACTIVITIES DESCRIBED HEREIN AND REQUESTED FROM CALIFORNIA PRIDE ALL-STARS.

Parent Signature*

(Athlete must sign for themselves if over 18)

Date*