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9th Annual Boston WIFFLE Ball Challenge
June 13, 2019 from 5:30pm to 9:30pm

Permission Form and Waiver

Waiver, Trademark and Management: By signing this release form for participation in the Boston WIFFLE® Ball Challenge (hereinafter “Event”), Participant and/or their parent or guardian acknowledges the inherent risks involved with the physical activity of participating in the Event and agree to assume all such risk. Said Participant and/or their parent or guardian hereby releases Franciscan Children’s, Travis Roy Foundation, Inc., Blue Sky Sports & Entertainment, LLC, and any of their parents, affiliates, subsidiaries, directors, officers and employees (collectively referred to as “Event Organizers”), Boston University and its employees and agents, from any liability or claim for any accident, death, bodily injury or illness, personal injury and theft or loss of personal property that may occur during the Event or as a result of the Event. It is also understood that Event Organizers, do not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance in the event of injury, illness, death or property damage. Participant acknowledges that all players must wear socks and sneakers. Footwear will be inspected, and those not wearing appropriate attire will not be allowed to participate.

Participant and/or their parent or guardian, acknowledges that Event Organizers may make sound recordings and take photographs or motion pictures during the Event (“Materials”), which may be used in television, radio, internet, and other forms of media for publicity, commercial, promotional and advertising purposes. Participant’s likeness may be used as described above without any compensation to Participant. Participant and/or their parent or guardian, hereby assigns the copyright of said Materials to Event Organizers and releases Event Organizers from any liability arising out of such use of Participant’s likeness as described above.

In the case of a medical emergency, Participant and/or Participant’s parent or guardian hereby authorizes the Event Organizers to act on their behalf to obtain emergency treatment for themselves or their son/daughter by any recognized hospital, doctor or emergency medical technician and hereby releases and forever discharges Event Organizers from any claims whatsoever which arise or may hereafter arise on account of any first aid treatment, emergency room treatment or other medical services rendered in connection with the Event and the activities at the Event.

By signing below, I state that I am the person or the parent/legal guardian of the minor child named below and confirm that I have read and understand the above statement regarding participation and release of liability in the Boston WIFFLE® Ball Challenge, and approve of its terms on behalf of myself or my child.

Today's Date: April 23, 2019

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Please Disclose Any Medical Conditions:
First Participant's Signature*
Second Participant's Name

First Name*

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

Please Disclose Any Medical Conditions:
Third Participant's Name

First Name*

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

Please Disclose Any Medical Conditions:
Fourth Participant's Name

First Name*

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

Please Disclose Any Medical Conditions:
Fifth Participant's Name

First Name*

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

Please Disclose Any Medical Conditions:
Sixth Participant's Name

First Name*

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

Please Disclose Any Medical Conditions:
Seventh Participant's Name

First Name*

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

Please Disclose Any Medical Conditions:
Eighth Participant's Name

First Name*

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

Please Disclose Any Medical Conditions:
Ninth Participant's Name

First Name*

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

Please Disclose Any Medical Conditions:
Tenth Participant's Name

First Name*

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

Please Disclose Any Medical Conditions:
Participant'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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
Company
What Team are you on?*
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

Please Disclose Any Medical Conditions:
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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