BTGA Registration & Liability Form 2020

Athlete's Name *

First Name

Last Name

Athletes Birthdate *

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Cell Phone Number *

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Emergency Contact Phone Number *

Cannot be the same number as above

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LIABILITY WAIVER *

In consideration for the child to be able to participate in THE BEYOND THE GAME ACADEMY (“Activity”) I, the undersigned, as the parent or guardian of my child, hereby state and agree as follows: 1. I am fully aware of the risks and hazards connected with participating in this Activity and in generally participating in sports. I understand that these risks include, but are not limited to, tripping, falling, colliding with objects or other participants, loss of consciousness, head injuries, dizziness, dehydration, lacerations, fainting, serious neck and spinal injuries, complete or partial paralysis, serious injury to all bones, joints, ligaments, muscles, tendons and other aspects of the musculoskeletal system, concussions, drowning and even death. I also acknowledge that the facilities of Franklin Academy, including but not limited to intramural field/playground, outdoor basketball court, and the gymnasium, fitness center, classrooms, contain inherent risks of injury. I voluntarily allow my child to participate in this Activity, even though I know such Activity may be hazardous for my child. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH that may be sustained by my child, or any loss or damage to property owned by my child, which may result, directly or indirectly, from my child’s participation in this activity, and I hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Missy West, The Beyond The Game Academy - ORCA LEADERSHIP,LLC and her employee’s or Franklin Academy, its trustees, officers, servants, agents, employees, or volunteers from any and all liability, claims, demands, actions and causes of action arising out of or related to any loss, damage, or injury, including death, that may be sustained by my child or to any property belonging to my child while participating in the Activity, on School premises, using The Beyond the Game – ORCA LEADERSHIP, LLC or using school facilities, unless any such damage or injury is primarily the direct result of negligence or intentional misconduct of Beyond The Game Academy or any of its officers, employees or lawful agents. 2. I also understand and agree that my child may be sent home or not be allowed to participate in the activity or activities if my child leaves the gym, fails to follow the coaches or Franklin Academy’s school rules and policies, or disregards the instructions of The Beyond the Game Academies directors, coaches and school’s employees and agents. No refunds of payment will be reimbursed. 3. I certify to Beyond the Game Academy directors and coaches, ORCA Leadership, LLC and Franklin Academy that my child has adequate health insurance to cover any medical costs including any kind of co-pay that may arise directly or indirectly from participating in this Activity. I further represent to Missy West & the Coaches of Beyond the Game Academy and the school that my child has no medical conditions that would prevent or hinder my child’s participation in this activity. 1 4. I understand that The Beyond the Game Academy will not have medical personnel present at the Activity. I hereby grant Missy West and her employee’s as well as Franklin Academy’s personnel permission to authorize emergency medical treatment for my child, if necessary, and that such action by Missy West and her employees shall be subject to the terms of this Agreement. I understand and agree that Missy West, her employee’s, and Franklin Academy Personnel assumes no responsibility for any injury or damage that may arise from medical treatment. 5. I further agree to indemnify and hold harmless Missy West and her employee’s and Franklin Academy from any loss, liability, damage or costs, including court costs and attorney’s fees that The Beyond the Game Academy-ORCA Leadership, LLC may incur in connection with my child’s participation in this Activity unless any such costs or damage is primarily the direct result of negligence or intentional misconduct of Missy West or any of its officers, employees or lawful agents. 6. It is my express intent that this Agreement, including the release and waiver of liability, covenant not to sue, and hold harmless provision, shall bind the members of my family and spouse, if I am alive, and my heirs, assigns, personal representative, if I am deceased. 7. I agree that the laws of the State of New York shall govern this agreement. 8. I acknowledge that The Beyond the Game Academy does not require my child to participate in this Activity for academic reasons or for other purposes. Check the box if you agree to the terms and conditions of this waiver:

I Accept

Date of Signature *

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