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5-Star Northeast

www.5starne.com

267-477-1478

5-Star NE, LLC, 5-Star Northeast, A2iFit, IS NOT RESPONSIBLE FOR ANY INJURY (OR LOSS OF PROPERTY) TO ANY PERSON SUFFERED WHILE PLAYING, PRACTICING OR IN ANY OTHER WAY INVOLVED IN 5-Star Northeast FOR ANY REASON WHATSOEVER, INCLUDING ORDINARY NEGLIGENCE ON THE PART OF THE 5-Star Northeast OR ITS AGENTS, EMPLOYEES, SPONSORS, VOLUNTEERS, THE OWNERS AND LESSORS OF THE PREMISES AND ALL OTHERS WHO ARE INVOLVED.

In consideration of my being allowed to participate in any way in the 5-Star Northeast related events and activities I hereby release and covenant not-to-sue 5-Star Northeast and any of their employees, instructors or agents, from any and all present and future claims resulting from ordinary negligence on the part of the 5-Star Northeast, its officers, officials, agents, employees, other participants, sponsors, advertisers, and owners and lessors of the premises or others listed for property damage, personal injury or wrongful death, arising as a result of my engaging in or receiving instruction at the 5-Star Northeast, programs and activities incidental thereto, wherever, whenever, or however the same may occur. I hereby voluntarily waive any and all claims resulting from ordinary negligence, both present and future, that may be made by me, my family, estate, heirs, or assigns. Further, I am aware that baseball and softball and other sports are vigorous team sports at times involving severe cardiovascular stress and violent physical contact. I understand that baseball and softball and other sports involve certain risk, including but not limited to death, serious neck and spinal injuries resulting in complete or partial paralysis, brain damage and serious injury to virtually all bones, joints, muscles and internal organs, and that equipment provided for my protection may be inadequate to prevent serious injury. I further understand that baseball and softball and other sports involve a particularly high risk of ankle, knee, head, and neck injury. In addition, I understand that participation at 5-Star Northeast involves activities incidental thereto, including but not limited to, travel to and from the site activity, participation at sites that may be remote from available medical assistance, and possible reckless conduct of other participants. I am voluntarily participating in this activity with knowledge of the danger involved and hereby agree to accept any and all inherent risks of property damage, personal injury, or death. I further agree to indemnify and hold harmless the 5-Star Northeast and others listed for any and all claims arising as a result of my engaging in or receiving instruction in the 5-Star Northeast activities or any activities incidental thereto, wherever, whenever, or however the same may occur. I have private insurance coverage for the participant and will list the carrier and policy number below. In the absence of this information, I assume all liability for such expenses. I understand that this waiver is intended to be as broad and inclusive as permitted by the laws of Pennsylvania, New Jersey or any state where 5-Star Northeast provides a physical location and agree that if any portion is held invalid the remainder of the waiver will continue in full legal force and effect. I further agree that the venue for any legal proceeding shall be in the state of Pennsylvania.

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Email Address

Email
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*

I, as the Parent, Legal Guardian or representative of Renting Organization, have read and understand then disclaimer as it pertains to rentals and use of the 5-Star facility training and clinics.



By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Name

First Name*

Last Name*

Phone*
Age Acknowledgment*
Date of Birth*
I certify that I am 18 years of age or older
Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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