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Liability and Photo Release
Must be signed by everyone 18 years or older

I shall indemnify, defend, and hold harmless National Athletic Village, LLC and its agents from and against any and all demands, claims, damages to persons and property, losses, and liabilities, including reasonable attorney’s fees arising out of or caused by you in connection with the provision of the services of National Athletic Village except to the extent and percentage attributed to the fault of National Athletic Village.

I hereby give permission for images of myself and any members of my party attending the National Athletic Village, including any children attending, captured through statements, video, photos, audio recorder and digital camera, to be used solely for the purposes of National Athletic Village promotional, commercial materials and publications, and waive any rights of control, compensation or ownership thereto. Such release, waiver and discharge shall also extend to all affiliated companies, shareholders, directors, officers, employees, agents and assigns of NAV. This Release shall be binding upon the minor and me, and our respective successors, heirs, assigns, executors, administrators, spouse and next of kin.

Athletes, parents, guests, children, and fans will decline use of facility if unable to be recorded.

I recognize the difficulty of opting out of the recordings of a large event and recognize that a condition to entering the facility is allowing the recording to be used in any capacity by NAV and its agents in order to promote, explain, and support the facility.

National Athletic Village, LLC, also known as NAV, is a business of the state of North Carolina. National Athletic Village is its own legal entity and its actions are not the responsibility of its sponsor companies. Sponsors are strictly buying advertising from National Athletic Village, LLC.

Please park in designated parking and not on grass. You will be ticketed for repair of tire track damage. Southern Pines requires all cars to be on asphalt, no gravel or grass parking allowed.

I have read this document and I understand that I give up substantial rights on behalf of the minor and myself and my party including rights relating to publicity and privacy with respect to the commercial use of any statements, photographs, and/or audio or video recordings and I sign this release voluntarily. I and the minors and guests I represent agree to abide by them at the NAV.

Date: November 22, 2019

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
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 (Optional):

Emergency Number:
Referals
How did you hear about us?*
Social Media
Word-of-Mouth
Google Search
What brings you here?
What brings you to the NAV today?*
5k Run
Adult Soccer
Airsoft
Archery
Basketball
Birthday Party
Day Pass
Event
Field Hockey
Futsal
Karate
Lacrosse
Rugby
Tournament
Volleyball
Youth Soccer
The Beach
Dance
Performance Gym
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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
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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