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IF YOU ARE UNDER 18 YEARS OF AGE, THIS DOCUMENT MUST BE SIGNED BY A PARENT OR GUARDIAN.
 

ACKNOWLEDGEMENT OF RISK, RELEASE OF LIABILITY, INDEMNIFICATION AGREEMENT, AND COVENANT NOT TO SUE

WAIVER FOR 4 STATES SPORTS, LLC 

In consideration of being allowed to participate in any training, events and activities (“Activities”) associated with The Resilience Foundation and 4 States Sports, LLC, a/k/a The Sports Facility, a/k/a 4 States Sports, I the undersigned, acknowledge and agree that:

The risk of injury from the training, events and activities (“Activities”) at The Sports Facility or at any event being sponsored by The Resilience Foundation or 4 States Sports, LLC, is significant, including the potential for permanent paralysis and death, and while particular training skills, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist.

I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM NEGLIGENCE OF THE RELEASEES (as defined below) or others and assume full responsibility for my participation in Activities at The Sports Facility or at any event being sponsored by The Resilience Foundation or 4 States Sports, LLC. Despite such risks, I willingly agree to participate in Activities at The Sports Facility or at any event being sponsored by The Resilience Foundation or 4 States Sports, LLC and comply with the terms and conditions for participation in the Activities at The Sports Facility, which I acknowledge receiving and understand completely. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and will notify The Sports Facility of such hazard immediately.


I certify that I am physically and mentally fit to participate in Activities at The Sports Facility and have not been advised by a qualified medical professional not to participate in any Activities such as those offered at The Sports Facility. I certify that there are no health-related reasons or problems which preclude my participation in these Activities or event and have disclosed to The Sports Facility any underlying medical conditions including COVID-19.

I herby consent to receive medical treatment which may be deemed advisable by The Sports Facility in the event of injury, accident, and/or illness during my participation in Activities at The Sports Facility. I agree that I will not hold the Releasees responsible for any claims resulting from any medical treatment I receive. I certify that I currently have medical/health insurance to cover any injuries that I may sustain during my participation in Activities at The Sports Facility.

I RELEASE, WAIVE, AND DISCHARGE ANY AND ALL CLAIMS that I or my heirs, assigns, personal representatives and next of kin may have now or in the future against The Sports Facility and it’s officers, directors, employees, contractors, subcontractors, sponsors, suppliers, national organizations or associations, representatives, agents, affiliates, insurers, successors and assigns; other participants, teams sponsors and advertisers of the Activities at The Sports Facility; and, if applicable, owners and lessors of the premises used by The Sports Facility (collectively the “Releasees”) for any liability, expenses, loss or damage to person or property, injury, death or disability suffered from or ini connection with my presence to participation in the Activities at The Sports Facility sue to any cause whatsoever, INCLUDING THE NEGLIGENCE ON THE PART OF THE RELEASEES. I HERBY AGREE NOT TO SUE OR MAKE CLAIMS AGAINST THE RELEASEES AND GIVE UP ALL OF MY RIGHTS TO DO SO.

I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY, DEFEND AND HOLD HARMLESS the Releasees, WITH RESPECT TO ANY AND ALL LIABILITY, INJURY DISABILITY, DEATH or loss or damage to person or property, or expenses or fees (including reasonable attorney’s fees) associated with my presence or participation in the Activities at The Sports Facility, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

This Agreement supersedes any prior agreements or understandings between Participant or Parent and The Sports Facility concerning the subject matter of the Agreement and will remain in effect and unless and until terminated or replaced by a new written agreement.

This Agreement and any disputes arising out of or related to participant’s involvement in Activities at The Sports Facility or this agreement shall be governed by, construed and enforced in accordance with the laws of the State of Missouri without regard to conflict of law principles. Jurisdiction and venue for any disputes arising out of or related to Participant’s involvement in Activities at The Sports Facility or this Agreement shall be exclusively in the Newton County Civil Courts or Newton County Circuit Courts.

If any provision of this Release of Liability, or the application of such provision, shall be rendered or declared invalid by a court of competent jurisdiction, or by reason of its requiring any steps, actions or results, the remaining parts or portions of this Release shall remain in full force and effect.

I HAVE READ THIS RELEASE OF LIABILITY, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT AN INDUCEMENT.

I Agree
 

FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINORITY AGE:

(Under age 18 at time of registration)

This is to certify that I am the parent of guardian of the minor Participant named above, having legal responsibility for this minor and I do hereby consent (with the approval of my spouse, if any) to the minor’s participation in the Activities at The Sports Facility and agree to the Release of Liability as provided above and hereby make and enter in to each and every representation, certification, waiver, release, assumption and indemnity described above in the Release of Liability on behalf of myself, the minor, any other parent or guardian of the minor, and our heirs, assigns, personal representatives, and next of kin.

I agree to give up my rights, the minor’s rights, and the rights of any other parent or guardian to maintain any claim or suit against Releasees arising out of the minor’s presence or participation in the Activities at The Sports Facility. I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THESE WAIVERS AND RELEASES, and I agree to indemnify and defend the Releasees for all liability arising out of any lack of authority on my part to make such waivers and releases.

I Agree
 

PHOTOGRAPHY RELEASE

I hereby agree to allow The Resilience Foundation and 4 States Sports, LLC (“The Sports Facility”) to record and publish photos and videos (including audio) of myself for the purpose of promoting The Sports Facility in a manner that does not violate the NCAA ByLaw 12.5.2 and for documenting and/or reporting events and activities. I understand photographs, video and/or audio tape recordings may be taken of myself and/or family members at practice, during competition, recreational play as well as other related events at The Sports Facility or other The Resilience Foundation and 4 States Sports, LLC sponsored events . I understand that this media will be produced and used for promotional purposes that do not violate NCAA Bylaw 12.5.2, and I authorize The Sports Facility to use my/our photograph, video and/or audio recording on it’s Websites and social media platforms, such as Facebook, Instagram, Twitter, YouTube, TicToc, Pinterest, etc., as well as other official printed publications without further consideration. In addition, I acknowledge The Sports Facility right to crop or treat the media at its discretion, and I also acknowledge that The Sports Facility may choose not to use my/our image at this time, but may do so at its own discretion at a later date.

I also understand that once I, or my family members, image(s) have been captured, they may be posted on The Sports Facility websites or social media platforms, the image can be downloaded by any computer user on or off the premises of The Sports Facility. The Resilience Foundation and 4 States Sports, LLC also reserves the right to discontinue use of photos without notice.

I HAVE READ THIS RELEASE OF LIABILITY AND PHOTOGRAPHY RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I Agree
  

COVID-19 RELEASE

I understand that The Sports Facility, it's employees and contractors are following a strict regimen of screening guests and participants for COVID-19 and that I will be asked questions about my health when I arrive. I also understand that they are cleaning surfaces on a regular basis throught the day and that I may be asked to wait while a surface is cleaned (logs of cleaning surfaces are kept). In addition I agree to wear a face mask if, if asked to do so, while on the premises.

I agree to give up my rights, the minor’s rights, and the rights of any other parent or guardian to maintain any claim or suit against Releasees arising out of anyone in my party's presence or participation in the Activities at The Sports Facility that might have led to the exposure and/or contraction of COVID-19 or any other contagious disease. I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THESE WAIVERS AND RELEASES, and I agree to indemnify and defend the Releasees for all liability arising out of any lack of authority on my part to make such waivers and releases.

I Agree
 

TANNING BED AND EQUIPMENT RELEASE

I recognize that there could be dangers inherent in tanning for some individuals. I acknowledge that the possibility of certain unusual physical changes during tanning does exist. I have been advised of the following risks in connection with my use of the tanning facilities at 4 States Sports or elsewhere. Prior to participation in tanning, it is advised that a full examination be given by my physician.

1. AVOID OVEREXPOSURE. As with natural sunlight, overexposure can cause eye and skin injury and allergic reactions. Repeated Overexposure may cause photo aging of the skin, dryness, wrinkling and in some instances skin cancer. We recommend that you do not tan outdoors on days you are tanning indoors, that you do not tan if you currently have a sunburn and that you, at most, tan only once in a 24 hour period.

2. MEDICAL / PRODUCT INTERACTIONS. Certain Medications, Lotions and other Products may cause your skin to be more sensitive to UV Rays. Check with your physician or pharmacist if you are unsure about any medications you are taking or if you have had a problem with indoor or outdoor tanning in the past.

3. WEAR PROTECTIVE EYEWEAR. Failure to wear protective eyewear may result in severe burn or long-term injury to the eyes.

Acknowledgment and Agreement

In any event, I acknowledge and agree that I assume the risks associated with any and all activities involving tanning beds or products in which I participate. I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from this program and/or activity. I understand that results are individual and may vary. I have read the contents of this consent form carefully and state that I am not aware of any medical condition or other reason that would prohibit me from tanning. I understand that I will not be allowed to exceed the maximum allowable time posted on the tanning device. I have been given adequate instructions for the proper use of the tanning equipment, understand the risks involved, and use it at my own risk. I hereby agree to release the owners, operators and manufacturers from any damages that I might incur due to the use of this facility.

I Agree
 

 

First Participant's Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone 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*

Relationship*

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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