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This release form is required for all participants at Tribe Athletics.

 

TRIBE ATHLETICS, INC. RELEASE FORM

READ THIS DOCUMENT COMPLETELY BEFORE SIGNING. ITS EFFECT IS TO RELEASE TRIBE ATHLETICS, INC., ITS COACHES, STAFF, AND OTHERS WORKING IN ITS EMPLOY, FROM ANY LIABILITY RESULTING FROM YOUR PARTICIPATION IN THE ACTIVITIES DESCRIBED BELOW AND WAIVES ALL CLAIMS FOR DAMAGES OR LOSSES AGAINST TRIBE ATHLETICS, INC.  IT ALSO GRANTS TRIBE ATHLETICS, INC. THE RIGHT TO USE OF THE ATHLETE’S LIKENESS IN PROMOTIONS, MARKETING, AND ANY OTHER BUSINESS RELATED ACTIVITIES.

This completed form will enable health facilities and the staff of TRIBE ATHLETICS, INC. to provide prompt care to your minor child, if necessary.

All Areas of This Form Must Be Completed.

MEDICAL RELEASE

I/We, the undersigned hereby certify that I/we am/are the parent or legal guardian of the Cheer Athlete (as set forth above). I/We hereby give permission for TRIBE ATHLETICS, INC. to seek, during the period of the cheerleading season, appropriate medical attention for the Cheer Athlete and for medical attention to be given and for the Cheer Athlete to receive medical attention in the event of accident, injury, illness, or otherwise, prior to, during, or after any activity related to cheerleading including but not limited to practice, competitions and/or performances, fundraisers, and etc.

I/We will be responsible for any and all costs of medical attention and treatment. I/We, the undersigned, for ourselves and as the guardians of the athlete understand that cheerleading is an active, physical sport, and that injuries can take place during practice, competitions and/or performances, or any other event where the Cheer Athlete is engaging in these activities. There are risks and dangers associated with participation in cheerleading including, but not limited to those of bodily injury, partial and/or total disability, paralysis, death, and property damage. I/We fully understand that cheerleading involves motion, rotation, and height, in a unique environment, and as such, I/we am/are aware of the risks and dangers which may be associated with the Cheer Athlete’s participation in such activities and am/are unaware of any health issues that would preclude this Cheer Athlete from participation. I/We understand, accept and assume those risks and dangers and waive any claims or causes of action for death, personal injury, property damage or otherwise which the Cheer Athlete named above may now have or hereafter have against TRIBE ATHLETICS, INC., its coaches, staff, or others in its employ, arising out of the Cheer Athlete’s participation in the cheerleading activities including, without limitation, all claims or causes of action for death personal injury, property damage or otherwise resulting from risks and dangers inherent in cheerleading, whether, practice, competition and/or performances, or any other event where the Cheer Athlete is engaging in these activities.

I/We also understand that it is my/our responsibility in caring for the Cheer Athlete listed above, and to be assured that he/she is fully capable of engaging in this sport’s activity, and I/we am/are confident that he/she is able to engage in such a sport.  In the event the Cheer Athlete listed above is unable to engage in activity necessary described above, we will immediately notify TRIBE ATHLETICS, INC. of such.

I/We, the undersigned for ourselves, our heirs, executors and administrators, waive, release and forever discharge TRIBE ATHLETICS, INC., its coaches, staff, and others working with this Cheer Athlete, from all rights and claims for damages, injury, or loss to person or property which may be sustained or occur during participation in any cheer related activities, whether or not damages, injury, or loss are due to the fault, negligence, or any other actions of TRIBE ATHLETICS, INC., its coaches, staff, or anyone working in its employ.

 

Signature of Parent(s)/Guardian(s):

Date: May 30, 2020

CONSENT TO USE OF ATHLETE’S LIKENESS

I/We, the undersigned do hereby certify that I/we am/are the parent or legal guardian of the Cheer Athlete (as set forth above).

I/We grant to TRIBE ATHLETICS, INC., the right to take and use photographs and/or videos of the Cheer Athlete in connection with any events surrounding the purposes of cheerleading including but not limited to practices, competitions, fundraising, etc..

I/We authorize TRIBE ATHLETICS, INC., its assigns and transferees to copyright, use and publish the same in print and/or electronically. I/We agree that TRIBE ATHLETICS, INC. may use such photographs/videos of the Cheer Athlete with or without their name and for any lawful purpose, including but not limited to such purposes as publicity, illustration, advertising, social media, and Web content. I/We have read and understood this consent and release.

I/We DO give my consent to TRIBE ATHLETICS, INC. to use this athlete’s name and likeness to promote the program, its fiscal agent, and/or their activities.

SIGNATURE(s):

DATE: May 30, 2020

ACKNOWLEDGEMENT

The Parent(s) or Guardian(s) of the Cheer Athlete further attest that they have read this entire agreement (consisting of four (4) pages) and are signing the same as his or her free act and/or deed.  The signees acknowledge that this Release includes legal terms and foregoes substantial rights of the individuals signing and of the Cheer Athlete, including any and all claims he or she may have existing now or in the future in any form against TRIBE ATHLETICS, INC., its coaches, staff, or others in its employ.  He or she has had an opportunity to seek legal counsel in regard to reviewing this release and has declined to obtain legal representation.  He or she also waives any further time to seek legal counsel and is signing this release voluntary, of their own free will, and with a full and complete understanding of its contents.

SIGNATURE(s):

DATE: May 30, 2020

First Athlete's Name

First Name*

Last Name*

Phone*
First Athlete's Date of Birth*
First Athlete's Information
Is the athlete taking any medications at this time that we should be aware of?*
No
Yes

List medications here
Does the athlete have any allergies we should know about? (food, drugs, asthma, etc) - please list below if yes*
No
Yes

Please list allergies here
Does the athlete have any previous injuries we should know about? If yes, please list below*
No
Yes

List any injuries here

List Date of Last Tetanus shot here. If unknown, please write "Unknown" or make your best estimate. *

Any other illness, disability, injury, special needs, limitations or otherwise not listed anywhere else on this form.

In case of emergency, who should we contact? *

Preferred Family Physician and Contact Number *
First Athlete's Signature*
Second Athlete's Name

First Name*

Last Name*
Second Athlete's Date of Birth*
Second Athlete's Information
Is the athlete taking any medications at this time that we should be aware of?*
No
Yes

List medications here
Does the athlete have any allergies we should know about? (food, drugs, asthma, etc) - please list below if yes*
No
Yes

Please list allergies here
Does the athlete have any previous injuries we should know about? If yes, please list below*
No
Yes

List any injuries here

List Date of Last Tetanus shot here. If unknown, please write "Unknown" or make your best estimate. *

Any other illness, disability, injury, special needs, limitations or otherwise not listed anywhere else on this form.

In case of emergency, who should we contact? *

Preferred Family Physician and Contact Number *
Third Athlete's Name

First Name*

Last Name*
Third Athlete's Date of Birth*
Third Athlete's Information
Is the athlete taking any medications at this time that we should be aware of?*
No
Yes

List medications here
Does the athlete have any allergies we should know about? (food, drugs, asthma, etc) - please list below if yes*
No
Yes

Please list allergies here
Does the athlete have any previous injuries we should know about? If yes, please list below*
No
Yes

List any injuries here

List Date of Last Tetanus shot here. If unknown, please write "Unknown" or make your best estimate. *

Any other illness, disability, injury, special needs, limitations or otherwise not listed anywhere else on this form.

In case of emergency, who should we contact? *

Preferred Family Physician and Contact Number *
Fourth Athlete's Name

First Name*

Last Name*
Fourth Athlete's Date of Birth*
Fourth Athlete's Information
Is the athlete taking any medications at this time that we should be aware of?*
No
Yes

List medications here
Does the athlete have any allergies we should know about? (food, drugs, asthma, etc) - please list below if yes*
No
Yes

Please list allergies here
Does the athlete have any previous injuries we should know about? If yes, please list below*
No
Yes

List any injuries here

List Date of Last Tetanus shot here. If unknown, please write "Unknown" or make your best estimate. *

Any other illness, disability, injury, special needs, limitations or otherwise not listed anywhere else on this form.

In case of emergency, who should we contact? *

Preferred Family Physician and Contact Number *
Fifth Athlete's Name

First Name*

Last Name*
Fifth Athlete's Date of Birth*
Fifth Athlete's Information
Is the athlete taking any medications at this time that we should be aware of?*
No
Yes

List medications here
Does the athlete have any allergies we should know about? (food, drugs, asthma, etc) - please list below if yes*
No
Yes

Please list allergies here
Does the athlete have any previous injuries we should know about? If yes, please list below*
No
Yes

List any injuries here

List Date of Last Tetanus shot here. If unknown, please write "Unknown" or make your best estimate. *

Any other illness, disability, injury, special needs, limitations or otherwise not listed anywhere else on this form.

In case of emergency, who should we contact? *

Preferred Family Physician and Contact Number *
Sixth Athlete's Name

First Name*

Last Name*
Sixth Athlete's Date of Birth*
Sixth Athlete's Information
Is the athlete taking any medications at this time that we should be aware of?*
No
Yes

List medications here
Does the athlete have any allergies we should know about? (food, drugs, asthma, etc) - please list below if yes*
No
Yes

Please list allergies here
Does the athlete have any previous injuries we should know about? If yes, please list below*
No
Yes

List any injuries here

List Date of Last Tetanus shot here. If unknown, please write "Unknown" or make your best estimate. *

Any other illness, disability, injury, special needs, limitations or otherwise not listed anywhere else on this form.

In case of emergency, who should we contact? *

Preferred Family Physician and Contact Number *
Seventh Athlete's Name

First Name*

Last Name*
Seventh Athlete's Date of Birth*
Seventh Athlete's Information
Is the athlete taking any medications at this time that we should be aware of?*
No
Yes

List medications here
Does the athlete have any allergies we should know about? (food, drugs, asthma, etc) - please list below if yes*
No
Yes

Please list allergies here
Does the athlete have any previous injuries we should know about? If yes, please list below*
No
Yes

List any injuries here

List Date of Last Tetanus shot here. If unknown, please write "Unknown" or make your best estimate. *

Any other illness, disability, injury, special needs, limitations or otherwise not listed anywhere else on this form.

In case of emergency, who should we contact? *

Preferred Family Physician and Contact Number *
Eighth Athlete's Name

First Name*

Last Name*
Eighth Athlete's Date of Birth*
Eighth Athlete's Information
Is the athlete taking any medications at this time that we should be aware of?*
No
Yes

List medications here
Does the athlete have any allergies we should know about? (food, drugs, asthma, etc) - please list below if yes*
No
Yes

Please list allergies here
Does the athlete have any previous injuries we should know about? If yes, please list below*
No
Yes

List any injuries here

List Date of Last Tetanus shot here. If unknown, please write "Unknown" or make your best estimate. *

Any other illness, disability, injury, special needs, limitations or otherwise not listed anywhere else on this form.

In case of emergency, who should we contact? *

Preferred Family Physician and Contact Number *
Ninth Athlete's Name

First Name*

Last Name*
Ninth Athlete's Date of Birth*
Ninth Athlete's Information
Is the athlete taking any medications at this time that we should be aware of?*
No
Yes

List medications here
Does the athlete have any allergies we should know about? (food, drugs, asthma, etc) - please list below if yes*
No
Yes

Please list allergies here
Does the athlete have any previous injuries we should know about? If yes, please list below*
No
Yes

List any injuries here

List Date of Last Tetanus shot here. If unknown, please write "Unknown" or make your best estimate. *

Any other illness, disability, injury, special needs, limitations or otherwise not listed anywhere else on this form.

In case of emergency, who should we contact? *

Preferred Family Physician and Contact Number *
Tenth Athlete's Name

First Name*

Last Name*
Tenth Athlete's Date of Birth*
Tenth Athlete's Information
Is the athlete taking any medications at this time that we should be aware of?*
No
Yes

List medications here
Does the athlete have any allergies we should know about? (food, drugs, asthma, etc) - please list below if yes*
No
Yes

Please list allergies here
Does the athlete have any previous injuries we should know about? If yes, please list below*
No
Yes

List any injuries here

List Date of Last Tetanus shot here. If unknown, please write "Unknown" or make your best estimate. *

Any other illness, disability, injury, special needs, limitations or otherwise not listed anywhere else on this form.

In case of emergency, who should we contact? *

Preferred Family Physician and Contact Number *
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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
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.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Is the athlete taking any medications at this time that we should be aware of?*
No
Yes

List medications here
Does the athlete have any allergies we should know about? (food, drugs, asthma, etc) - please list below if yes*
No
Yes

Please list allergies here
Does the athlete have any previous injuries we should know about? If yes, please list below*
No
Yes

List any injuries here

List Date of Last Tetanus shot here. If unknown, please write "Unknown" or make your best estimate. *

Any other illness, disability, injury, special needs, limitations or otherwise not listed anywhere else on this form.

In case of emergency, who should we contact? *

Preferred Family Physician and Contact Number *
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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