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Active Kids

Liability and Medical Waiver

Today's Date: November 16, 2019

Waiver of Liability

SPORTS ACADEMY THOUSAND OAKS, LLC (hereinafter referred to as "SPORTS ACADEMY") is a multi-purpose sports, training, and recreation center that provides a wide variety of sports and activities for participants of all ages both onsite (the “Main Campus”) and offsite at other facilities that may be owned, leased, operated and/or used by SPORTS ACADEMY (collectively referred to herein as the “Other Facilities”, and together with the Main Campus, referred to herein as the “Facilities”). Some of the activities offered include, without limitation, instruction, leagues, tournaments, , fitness activities (including yoga, individualized personal training and group fitness classes), self defense (Close Quarters Defense®) classes, parent/child classes, summer camps, birthday parties, field trips, corporate outings, team building events, and company picnics (hereinafter collectively referred to as "Activities"). The Facilities are also available for individual, team and/or group rental. Some of the many benefits of SPORTS ACADEMY Activities include improved fitness, opportunity to compete and excel, improved self confidence, better health, increased sense of belonging, wholesome recreation, social interaction, improved self image, weight loss, and improved appearance. The physical exertion required ranges from mild to very strenuous, depending on the activity and the motivation of the participant; the skill level required ranges from beginner to highly advanced, depending on the activity and competition; and the competitiveness of the activity ranges from moderate to highly competitive. Therefore, the individual participant is able to select Activities that fit his or her needs, abilities, and interests.

While the many benefits of these Activities are apparent, SPORTS ACADEMY and its staff regard participant safety as a top priority and feel it is important that the Participant/Parent [either an adult Participant OR a minor Participant and his/her parent(s)/guardian(s)] understand that there are risks inherent in all physical activity. SPORTS ACADEMY takes great care to reduce the risks associated with the many physical activities offered at the Facilities. However, regardless of the care taken to avoid injuries, some risks are inherent in any physical activity and cannot be totally eliminated without changing the nature of the activity. A few examples of the many inherent risks include, but are not limited to, heat-related illness; over-exertion; imperfect playing surfaces; failure to adhere to posted rules or warnings (Note: coaches or supervisors may be present for certain activities, but the Participant/Parent should have no expectation of supervision over an area or activity unless expressly specified otherwise); collisions with objects or co-participants; falls to the playing surface; unexpected equipment failure or malfunction (e.g., obstacles, fitness equipment, pitching machines, etc.); careless or erratic acts by co-participants; errors in judgment/supervision of supervisors, other employees, or officials; and being struck by an object (e.g. ball, puck, bat, stick, etc.). There are also inherent risks that are specific to a sport or activity – such as being kicked by a co-participant in soccer; being hit by a ball in basketball or volleyball; body contact in basketball; and, in the case of Close Quarters Defense training and instruction, physical contact including, but not limited to, kicking, punching, elbowing and other intentional acts that are otherwise intended to injure others. There are even inherent risks in being a spectator of a sport (e.g. being hit by a ball or participant, falling down stairs, etc.) or in non-sports Activities (i.e., birthday parties, camps, or team-building activities) and injuries can occur due to the enthusiasm of participants, reckless conduct, or failure to follow posted rules. The undersigned acknowledges that the Participant should be evaluated by his/her physician prior to participating in the Activities.

SPORTS ACADEMY believes that it is important that the Participant/Parent understand that these types of injuries can occur. Minor injuries are the most common and include, but are not limited to, muscle soreness, headaches, sprains/strains, abrasions, and bruises. Serious injuries are less common, but do occur occasionally. They include, but are not limited to, broken bones, concussions, torn ligaments or cartilage, eye injuries, cuts, and internal injuries. Catastrophic injuries are very rare, but SPORTS ACADEMY believes that every Participant/Parent should be aware of the slight possibility. Catastrophic injuries may include permanent disability and/or disfigurement, brain injury, paralysis and even death.

The undersigned Participant/Parent warrants and represents that he/she possesses the authority to execute this Waiver of Liability/Release of Claims on behalf of the above-named Participant. Participant/Parent acknowledges that Participant will be participating in and/or attending Activities at one or more of the Facilities.

ASSUMPTION OF RISKS: I, the undersigned Participant/Parent, understand that all Activities provided by SPORTS ACADEMY at the Facilities inherently involve the risk of bodily injury, including death, regardless of the care taken by SPORTS ACADEMY. By signing this waiver, Participant/Parent acknowledges that he/she has read and understood this Waiver of Liability and Release of Claims and that he/she knows, understands, and appreciates the risks and types of injuries inherent in the Activities. The Participant/Parent hereby acknowledges that participation in the Activities is voluntary and he/she knowingly assumes all inherent risks of the Activities, today and on all future dates.

WAIVER OF LIABILITY FOR CONDUCT OF SPORTS ACADEMY: In consideration of permission to use the Facilities, equipment, and services of SPORTS ACADEMY, today and on all future dates, I, the Participant/Parent, on behalf of myself, my spouse, heirs, executors, administrators, personal or legal representatives, and assigns (hereinafter collectively referred to as the "Releasing Parties") do hereby waive, release, discharge and covenant not to sue SPORTS ACADEMY (including Sports Academy Thousand Oaks, LLC, Sports Academy, LLC, Sports Academy Foundation) and all owners, officers, directors, members, partners, employees, agents, volunteers, parent companies, subsidiaries, affiliates, representatives, independent contractors, and equipment suppliers thereof; hereinafter collectively referred to as the "Releasees" from liability for any and all claims, demands, actions, losses, damages, injuries, or liabilities of any kind or nature, to the fullest extent allowed under the law, which are sustained, suffered or incurred by the Participant as a result of his/her participation in and/or attendance at any of the Activities in, on or around any of the Facilities. I, the Participant/Parent, on behalf of the Releasing Parties, further expressly assume all risks associated with participation in and/or attendance at the Activities in, on or around any of the Facilities.

This Waiver of Liability & Release of Claims applies to: (1) personal injury (including death) from incidents or illnesses arising from participation in SPORTS ACADEMY Activities including, but not limited to, recreational, practice, or competitive Activities; events; organized or individual training and conditioning Activities; individual or group instruction; as an observer or spectator; and individual use of all Facilities, including, without limitation, the associated sidewalks and parking lots of the Facilities, and/or equipment;and (2) any and all claims resulting from damage to, loss of, or theft of property.

INDEMNIFICATION:  Participant shall indemnify, defend and hold harmless the Releasees from and against any and all Claims resulting from, arising out of or in connection with Participant’s use of the Facilities and/or equipment, participation in and/or attendance at the Activities and/or Participant’s conduct and/or actions before, during and/or after the Activities (whether intentional or otherwise), whether resulting in whole or in part from the negligence of any Releasee; provided, however, that the foregoing indemnification shall not apply to any Claims that are ultimately found to have been caused by the willful misconduct of SPORTS ACADEMY.  

RIGHT OF PUBLICITY/PRIVACY: Participant/Parent acknowledges and understands that photography and/or audio-visual recording of SPORTS ACADEMY Activities can and does occur and, in consideration for the use of theFacilities and participation in and/or attendance at the Activities, Participant/Parent hereby unconditionally and irrevocably agrees to allow SPORTS ACADEMY to photograph and/or record Participant and/or Parent and to use any such photographs or recordings or Participant/Parent's name, likeness, voice, or other personal characteristics in any print, internet, radio television, billboard, social media, or multimedia advertising or marketing or for any commercially reasonable use whatsoever. Participant/Parent, on behalf of himself/herself and all Releasing Parties, hereby releases the Releasees from any and all claims and demands that may arise out of or in connection with the use of the photographs, recordings, or Participant/Parent's name, likeness, voice, or other personal characteristics, including without limitation any and all claims for libel or violation of any right of publicity or privacy.

Participant/Parent acknowledges and understands that the Participant’s personal data is collected during participation in theActivities.  Personal biometric data collection occurs in various forms, some of which involve sports performance, biomechanical assessments, recovery, sport- specific skill advancement, and questionnaires.   SPORTS ACADEMY’s biometric human performance data collection system is HIPAA compliant. In consideration of the use of the Facilities and/or participation in and/or attendance during Activities, Participant/Parent hereby unconditionally and irrevocably agrees to allow SPORTS ACADEMY to collect personal and biometric data and/or record Participant’s personal and biometric data to use in private evaluations, coaching sessions, presentations or educational research.

REPORTING OF HARASSMENT, ABUSE and NEGLECT: Participant/Parent further agrees that upon observing or experiencing any harassment, abuse, or neglect, whether it be physical, sexual, emotional, or psychological in nature, he/she shall immediately report such harassment, abuse, or neglect: (1) to the SPORTS ACADEMY supervisor on duty or, (2) if such supervisor participated or was involved in the harassment, abuse, or, neglect, to SPORTS ACADEMY'S Athletic Director, whose contact information is posted and/or is available online at www.sportsacademy.us and at the front desk of the Main Campus.

ACKNOWLEDGMENTS TO PROMOTE PARTICIPANT SAFETY: These affirmations aid SPORTS ACADEMY in providing for participant health and safety. 

Health Status. The Participant/Parent affirms that the Participant:

Possesses no health problems or physical disabilities that would make participation unwise, or risk injury. 

I Agree

Will cease activity and inform SPORTS ACADEMY of any health problem that arises during participation.

I Agree

Possesses sufficient skills, coordination, and physical fitness to safely participate.

I Agree

Medical Care. The Participant/Parent affirms that he or she:

Authorizes SPORTS ACADEMY to secure emergency medical care and transport if deemed necessary; SPORTS ACADEMY does not staff medical personnel.

I Agree

Agrees to assume all cost of the care and transportation listed above.

I Agree

Rules and Safety.  The Participant/Parent affirms that he or she agrees:

To report all injuries (even minor injuries) so that SPORTS ACADEMY may make a record of the injury.

I Agree

To wear all recommended safety gear during participation.

I Agree

To follow all rules of the Activities at SPORTS ACADEMY.

I Agree

To inform SPORTS ACADEMY of any conduct or condition that creates a hazard for participants or others – and will immediately discontinue further participation in Activities until the hazardous conduct or condition is remedied or abated and no longer presents a hazard.

I Agree

That SPORTS ACADEMY has authority to halt my participation if it endangers the Participant or others.

I Agree

I, the PARTICIPANT/PARENT confirm that:

1)     This agreement supersedes any and all previous oral or written promises or agreements. I understand that this is the entire agreement between me and SPORTS ACADEMY and that it cannot be modified or changed in any way by representations or statements by any agent or employee of SPORTS ACADEMY.

2)     The foregoing Waiver of Liability and Release of Claims Agreement is intended to be as broad and inclusive as is permitted by the laws of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

3)     If legal action is brought, the appropriate trial court for the County of Ventura in the State of California has the sole and exclusive jurisdiction and that only the substantive laws of the State of California shall apply.

4)     I will engage in good faith efforts to mediate any dispute that might arise. Any agreement reached will be formalized by a written contractual agreement at that time. Should the issue not be resolved by mediation, I agree that all disputes, controversies, or claims arising out of participation in SPORTS ACADEMY Activities shall be submitted to binding arbitration in accordance with the applicable rules of the American Arbitration Association then in effect.

The undersigned acknowledges that he/she has read and understands the foregoing, has been informed of the risks faced by the Participant as a result of Participant's participation in and attendance at the Activities and has voluntarily signed this Waiver of Liability & Release of Claims with full knowledge of the legal consequences of doing so. If Parent is signing this Waiver of Liability & Release of Claims, he/she represents and warrants that he/she has explained the risks of the Activities to the Participant and that Participant understand said risks and this agreement.

THIS WAIVER OF LIABILITY & RELEASE OF CLAIMS IS VALID INDEFINITELY UNLESS EXPRESSLY REVOKED IN WRITING, EXCEPT FOR THOSE PROVISIONS THAT ARE EXPRESSLY IRREVOCABLE. 

 

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Mamba Sports Academy Active Kids Participant Medical, Consent to Treat a Minor, Emergency Contact, & Pick-up Release Form

This must be completed and signed in all areas by his/her parent or guardian. I understand and agree that this document will be kept in the possession of authorized adult personnel and that reasonable care will be used to keep this information confidential. By signing this form the participant's guardian affirms having read and agreed to the terms and conditions listed below.

The below named parent/guardian of the Minor has entrusted, for a temporary period of time, the Minor into the care of Mamba Sports Academy and its staff, for particular reasons and for the welfare of the Minor. Participants parent/guardian does agree that he/she will remain onsite at all times, while the child is participating in the Active Kids program, and that this agreement will only be enforced if the parent is not located within a reasonable time frame to ensure the best care for the injured participant.

The parent/guardian does hereby authorize the Mamba Sports Academy Staff, as agent for the undersigned to any x-ray examination, anesthetic, emergency Paramedic treatment, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of, any physician and surgeon licensed under the provisions of the Modern Medical Practice Act or the medical staff of any hospital; or to consent to x-ray examination, anesthetic dental or surgical diagnosis or treatment to be rendered to the Minor by any dentist licensed under the provisions of the Dental Practice Act.

It is understood that this authorization is given in advance of any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care being required but is given to provide authority and power on the part of the Mamba Sports Academy Staff to give specific consent to any and all such examination, anesthetic, diagnosis, treatment or hospital care which the aforementioned surgeon, physician and/or dentist, in the exercise of his/her best judgment, may deem advisable. This authorization and the attached Caregiver's Authorization Affidavit are given pursuant to the provisions of Section 6550 and 6910* of the Family Code of California.

The parent hereby authorizes any hospital which has provided treatment to the Minor pursuant to the provisions of Section 6550 and 6910* of the Family Code of California to surrender physical custody of the Minor to the Agent upon the completion of treatment. This authorization is given pursuant to Section 1283** of the Health and Safety Code of California.

These authorizations shall remain effective for one year from date of signing unless sooner revoked in writing delivered to said, Agent.

*Family Code of California, Section 6910 The parent, guardian, or caregiver of a minor who is a relative of the minor and who may authorize medical care and dental care under Section 6550, may authorize in writing an adult into whose care a minor has been entrusted to consent to medical care or dental care, or both, For the minor.

**Health and Safety Code, Section 1283 (a) No health facility shall surrender the physical custody of a minor under 16 years of age to any person unless such surrender is authorized in writing by the child's parent, the person having legal custody of the child, or the "Caregiver of the child and who may authorize medical care and dental care under Section 6550 of the Family Code".

In case of Emergency:

  • A phone call to 911 is made.
  • Child's parents are contacted onsite.
  • Child is separated from the other children and appropriately cared for by medical staff on site or 911.
  • If a parent or guardian is not found, an ambulance will take the child to the site chosen by emergency medical responders/911.

Parent / Guardian Initials:

 

HEALTH MATTERS

For the health and safety of your child and all children in our Active Kids program, please do not bring your sick child to the facility.

Children with mild cold-like symptoms that are otherwise feeling and acting well, may participate in the classes.

  • Mild cold-like symptoms are clear, runny nose, slight cough, and no fever. If you are not sure if your child should participate in the Active Kids classes, please refrain from class that day.
  • Within our youth programming we do not allow our staff to give medications to children. Please plan to make yourself available if you must stick to a schedule with your child while present in a session.

If a child becomes ill during a session the parent will be notified to pick up their child.

  • Parents agree to pick up their child within one hour of notification.
  • If parents are not located in the building, the emergency contact person will be notified.

Parent / Guardian Initials:

 

SECURITY PROTOCOL FOR CHECK-IN AND PICK-UP

To ensure a safe and enjoyable experience in Mamba Sports Academy Active Kids for all children, the following policies and guidelines are mandatory:

The parent or legal guardian dropping off and picking the child up will be required to sign the Active Kids Sign In/Out Record Log, which includes:

  • Participant Name
  • Date / Time
  • Picked up by / Pick up cell#
  • Signature
  • Another approved adult, being named by the parent/guardian at check in and/or on the pick-up release form, may pick up the child if the person is able to show a current, approved photo identification.
  • If the pick-up person is not listed on the original or new pick-up form, we will contact the parent/guardian on the original form, verify this is an acceptable pick-up person and verify the person by an approved photo identification.
  • Any persons not legally authorized to pick-up the participant must also be listed.

 If you need an early drop-off time or late pick-up time, please contact us so we can set this up with you.

Parent / Guardian Initials:

Please select who will be participating...
Minor
Continue
First Participant's Name

First Name*

Last Name*

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

Please elaborate on any important medical history of which we should be aware:

Please list any medications currently being taken:

Please list any allergies (if none, please write "none"):

In an emergency situation, please write in or check below any non-perscription medications allowed to administer:

*SA is not authorized to administer any medication without parent/guardian written consent.

First Participant's Signature*
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*
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 / AUTHORIZED PICK UP*
Emergency / Pickup Contact 1
Relationship to Child*

Full Name *

Primary Phone: *
Emergency / Pickup Contact 2
Relationship to Child*

Full Name *

Primary Phone: *
Emergency / Pickup Contact 3
Relationship to Child

Full Name

Primary Phone
Emergency / Pickup Contact 4
Relationship to Child

Full Name

Primary Phone
Emergency / Pickup Contact 5
Relationship to Child

Full Name

Primary Phone
*All persons must present current photo I.D. upon pick-up.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Please elaborate on any important medical history of which we should be aware:

Please list any medications currently being taken:

Please list any allergies (if none, please write "none"):

In an emergency situation, please write in or check below any non-perscription medications allowed to administer:

*SA is not authorized to administer any medication without parent/guardian written consent.

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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