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5 Star Athletics yearly waiver and release of liability form

I certify that my child has no injuries or illnesses that would limit their participation in any 5 Star Athletics LLC program. I authorize 5 Star Athletics LLC staff to act for my child according to their best judgement in any emergency requiring medical attention. I hereby waive and release 5 Star Athletics LLC from any and all liability for any injury or illness incurred while participating in any practice. My child has medical coverage and I will be responsible for any expenses resulting from injury, illness, or accident incurred during any practice. I will grant authority to the first aid and CPR certified trainer on site to provide necessary and reasonable medical attention to my child.

In consideration for being permitted to utilize the services of 5 Star Athletics and/or for my children listed above to participate for any purpose including, but not limited to observation or use of 5 Star Athletics lessons equipment, or participation in any off-site program affiliated with 5 Star Athletics. The undersigned, on behalf of himself or herself and such participating children herby acknowledges, agrees and represents that he or she has inspected and carefully considered the premises, equipment and facilities and/or the affiliated program that the undersigned finds and accepts same as being safe and reasonably suited for the use or participation by the undersigned and such participating children. 

In addition the undersigned acknowledges that the novel coronavirus(“COVID-19”) infections have been confirmed throughout the United States, including thousands of cases in Maryland. In accordance with the most recent guidelines and protocols issues by the World Health Organization(WHO), the Centers for Disease Control and Prevention(CDC), the Maryland Department of Health, the undersigned hereby agrees, represents and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, service, and programs of 5 Star Athletics within 14 days after (i) returning from highly impacted areas subject to a CDC Level 3 Travel Health Notice, (ii) exposure to any person returning from such areas, or (iii) exposure to any person who has a suspected or confirmed case of COVID-19. The CDC travel health network is continuously updating this list and the undersigned agrees that they are aware of this list and the countries listed. The undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs of 5 Star Athletics if he or she (i) experiences symptoms of COVID-19 without a vaccination, including, without limitation, fever cough or shortness of breath, or (ii) has a suspected or diagnosed/confirmed case of COVID-19. The undersigned agrees to notify 5 Star Athletics immediately if he or she believes that any of the foregoing access/use restrictions may apply.

5 Star Athletics has taken certain steps to implement certain recommended guidance and recommendations issued by public health agencies for slowing the transmission of COVID-19, including, without limitation, the access/use restrictions set forth above. The undersigned acknowledges and agrees that 5 Star Athletics may revise its procedures at any time based on updated recommended guidance and recommendations issued by public health agencies and further agrees to comply with 5 Star Athletics revised procedures prior to utilizing the facilities, services, and/or prior to participating in the programs of 5 Star Athletics. The undersigned further acknowledges and agrees that, due to the nature of the facilities, services, and programs offered by 5 Star Athletics, social distancing of 6 feet per person among children and their fellow participants or others is not always possible. The undersigned fully understands and appreciates both the known and potential dangers of participating in the programs and/or utilizing the facilities and services of 5 Star Athletics and acknowledges that use thereof by undersigned and/or such participating children may, despite 5 Star Athletics reasonable efforts to mitigate such dangers, result in exposure to COVID-19, which could result in quarantine requirements, serious illness, disability, and/or death. 

THE UNDERSIGNED, ON HIS OR HER BEHALF AND ON BEHALF OF SUCH PARTICIPATING CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE 5 Star Athletics or any of their respective directors, employees, volunteers or any of the fellow participants or their family members or guests from all liability to the undersigned or such participating children and all personal representatives, assigns, heirs, and next of kin of the undersigned or such participating children for any loss or damage, and any claim or demands on account of any property damage or any injury to, or an illness or the death of, the undersigned or such participating children (or any person who may contract COVID-19, directly or indirectly, from the undersigned or such participating children) whether caused by the negligence, active or passive, of 5 Star Athletics or otherwise while the undersigned or such participating children are in, upon, or about the premises or any facilities or using any equipment of or participating in any program of or affiliated with 5 Star Athletics. 

I HAVE CAREFULLY READ AND VOLUNTARILY SIGN THIS ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY AGREEMENT AND FURTHER AGREE THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENT APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE. I AM AWARE THAT BY AGREEING TO THIS AGREEMENT I AM GIVING UP VALUABLE LEGAL RIGHTS, INCLUDING THE RIGHT TO RECOVER DAMAGES FROM THE ORGANIZATION IN CASE OF ILLNESS, INJURY, DEATH OR PROPERTY LOSS OR DAMAGE, INCLUDING, FOR THE AVOIDANCE OF DOUBT AND WITHOUT LIMITATION, EXPOSURE TO COVID-19 AT ANY 5 STAR ATHLETICS FACILITY OR DURING PARTICIPATION IN ANY PROGRAM AND ANY ILLNESS, INJURY OR DEATH RESULTING THEREFROM. I UNDERSTAND THAT THIS DOCUMENT IS A PROMISE NOT TO SUE AND A RELEASE OF AND INDENIFICATION FOR ALL CLAIMS. IF SIGNING ON BEHALF OF MINOR: I ALSO UNDERSTAND THAT THIS AGREEMENT IS MADE ON BEHALF OF MY MINOR CHILD(REN) AND/OR LEGAL WARDS AND I REPRESENT AND WARRANT TO THE ORGANIZATION THAT I HAVE FULL AUTHORITY TO SIGN THIS AGREEMENT ON BEHALF OF SUCH MINOR(S).

Photo Release:I further authorize the use of photos of my athlete taken while playing or practicing to be used on the 5 Star Athletic's website, in publicity materials or in other program material.

I Agree

I understand that this form is good for the calendar year stated above for any 5 Star Athletics Program. I understand that it is my reponsibility to update this form if changes occur.

 


First Athlete's Name

First Name*

Last Name*

Phone*
First Athlete's Age Acknowledgment*
First Athlete's Date of Birth*
I certify that I am 18 years of age or older
First Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
First Athlete's Signature*
Second Athlete's Name

First Name*

Last Name*
Second Athlete's Date of Birth*
Second Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Third Athlete's Name

First Name*

Last Name*
Third Athlete's Date of Birth*
Third Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Fourth Athlete's Name

First Name*

Last Name*
Fourth Athlete's Date of Birth*
Fourth Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Fifth Athlete's Name

First Name*

Last Name*
Fifth Athlete's Date of Birth*
Fifth Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Sixth Athlete's Name

First Name*

Last Name*
Sixth Athlete's Date of Birth*
Sixth Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Seventh Athlete's Name

First Name*

Last Name*
Seventh Athlete's Date of Birth*
Seventh Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Eighth Athlete's Name

First Name*

Last Name*
Eighth Athlete's Date of Birth*
Eighth Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Ninth Athlete's Name

First Name*

Last Name*
Ninth Athlete's Date of Birth*
Ninth Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Tenth Athlete's Name

First Name*

Last Name*
Tenth Athlete's Date of Birth*
Tenth Athlete's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Athlete's 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:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Join our mailing list!!
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Known Allergies/Health Issues/Medications

Any known?
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Athlete's Graduation Year:

Current Travel/Rec Team
Parent or Guardian's 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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