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This is the Emergency Medical Form, Release of Liability, Waiver of Claims, Indemnity Agreement, Commitment and Contract Waiver required for all participants.

 

AKNOWLEDGEMENT & ASSUMPTION OF RISKS, WAIVER OF CLAIMS, RELEASE OF LIABILITY AND INDEMNITY AGREEMENT 

WARNING: Please read carefully! By signing this document, you will waive certain legal rights - including the right to sue.

Every Person MUST read, complete and sign this waiver before participating in any program, event or activities as offered by  AFM Uxbridge Inc. (hereinafter the "Organization").

1. This is a binding legal agreement. Clarify any questions or concerns before signing. Prior to participating, an individual who is the age of majority or older and who wants to participate in the sport of cheerleading and the activities, programs, classes and services provided by, and/or in the events sponsored or organized by the Ontario Cheerleading Federation and AFM Uxbridge Inc. which may include but is not limited to: competitions, meets, practices, training, personal or strength training, dry land training, training using machines or weights, nutritional and dietary programs, orientational or instructional sessions or lessons, and aerobic and anaerobic conditioning programs (collectively the “Activities”) must acknowledge and agree to the terms outlined in this agreement.

Disclaimer

2. The Ontario Cheerleading Federation, AFM Uxbridge Inc., and their respective Directors, Officers, committee members, members, employees, coaches, volunteers, officials, participants, agents, sponsors, owners/operators of the facilities in which the Activities take place, and representatives (collectively the “Organization”) are not responsible for any injury, personal injury, damage, property damage, expense, loss of income or loss of any kind suffered by a Participant during, or as a result of, the Activities, caused in any manner whatsoever including, but not limited to, the negligence of the Organization.

I have read and agree to be bound by paragraphs 1 and 2

Description and Acknowledgement of Risks

3.I understand and acknowledge that:

a) The Activities have foreseeable and unforeseeable inherent risks, hazards and dangers that no amount of care, caution or expertise can eliminate, including without limitation, the potential for serious bodily injury, permanent disability, paralysis and loss of life
b)  The Organization may offer or promote online programming (such as webinars, remote conferences, workshops, and online training) which have different foreseeable and unforeseeable risks than in-person programming
c)  The Organization has a difficult task to ensure safety and it is not infallible. The Organization may be unaware of my fitness or abilities, may misjudge weather or environmental conditions, may give incomplete warnings or instructions, and the equipment being used might malfunction
d)  (COVID-19) The COVID-19 disease has been declared a worldwide pandemic by the World Health Organization and is extremely contagious. The Organization has put in place preventative measures to reduce the spread of COVID-19; however, the Organization cannot guarantee that I will not become infected with COVID-19. Further, participating in the Activities could increase my risk of contracting COVID-19

4. I am participating voluntarily in the Activities. In consideration of my participation, I hereby acknowledge that I am aware of the risks, dangers and hazards associated with or related to the Activities. I understand that the Organization may fail to safeguard or protect me from the risks, dangers and hazards of the Activities, some of which are listed below. The risks, dangers and hazards include, but are not limited to:

a)  Health: executing strenuous and demanding physical techniques; physical exertion; overexertion; stretching; dehydration; fatigue; cardiovascular workouts; rapid movements and stops; lack of fitness or conditioning; traumatic injury; sprains and fractures, spinal cord injuries, bacterial infections; rashes; and the transmission of communicable diseases, including viruses of all kinds, COVID-19, bacteria, parasites or other organisms or any mutation thereof
b)  Training Environment: defective, dangerous or unsafe condition of the facilities; falls; collisions with objects, walls, ground, equipment or persons; dangerous, unsafe, or irregular conditions on floors or other surfaces; and travel to and from the premises
c)  Use of equipment: mechanical failure of the equipment; negligent design or manufacture of the equipment; the provision of or the failure by the Organization to provide any warnings, directions, instructions or guidance as to the use of the equipment; failure to wear safety or protective equipment; and failure to use or operate equipment within my own ability
d)  Contact: contact with the floor, ground, props, other equipment, vehicles, spotters, or other persons; and other contact that may lead to serious bodily injury, including but not limited to concussions and/or other brain injury or serious spinal injury
e)  Advice: negligent advice regarding the Activities
f)  Ability: failing to act safely or within my own ability or within designated areas
g)  Sport: the sport of cheerleading and its inherent risks, including but not limited to flips, cartwheels, jumps (list other stuff here)
h)  Cyber: privacy breaches; hacking; and technology malfunction or damage
i)  Conduct: my conduct and conduct of other persons including any physical altercation between participants
j)  Travel: travel to and from the Activities
k)  Negligence: my negligence and negligence of other persons, including NEGLIGENCE ON THE PART OF THE ORGANIZATION, which may increase the risk of damage, loss, personal injury or death

I have read and agree to be bound by paragraphs 3 and 4

Terms

5.  In consideration of the Organization allowing me to participate in the Activities, I agree:

a)  That when I practice or train in my own space, I am responsible for my surroundings and the location and equipment that I select
b)  That my mental and physical condition is appropriate to participate in the Activities and I assume all risks related to my mental and physical condition
c)  To comply with the rules and regulations for participation in the Activities
d)  To comply with the rules of the facility or equipment
e)  That if I observe an unusual significant hazard or risk, I will remove myself from participation and bring my observations to a representative of the Organization immediately
f)  The risks associated with the Activities are increased when I am impaired and I will not to participate if impaired in any way
g)  That it is my sole responsibility to assess whether any Activities are too difficult for me. By commencing an Activity, I acknowledge and accept the suitability and conditions of the Activity
h)  That I am responsible for my choice of safety or protective equipment and the secure fitting of that equipment
i)  (COVID-19) That COVID-19 is contagious in nature and I may be exposed to, or infected by, COVID-19 and such exposure may result in personal injury, illness, permanent disability, or death

Release of Liability and Disclaimer

6.  In consideration of the Organization allowing me to participate, I agree:

a)  That the sole responsibility for my safety remains with me
b)  To ASSUME all risks arising out of, associated with or related to my participation
c)  That I am not relying on any oral or written statements made by the Organization or its agents, whether in a brochure or advertisement or in individual conversations, to agree to participate in the Activities
d)  To WAIVE any and all claims that I may have now or in the future against the Organization
e)  To freely ACCEPT AND FULLY ASSUME all such risks and possibility of personal injury, death, property damage, expense and related loss, including loss of income, resulting from my participation in the Activities
f)  To FOREVER RELEASE AND INDEMNIFY the Organization from any and all liability for any and all claims, demands, actions, damages (including direct, indirect, special and/or consequential), losses, actions, judgments, and costs (including legal fees) (collectively, the “Claims”) which I have or may have in the future, that might arise out of, result from, or relate to my participation in the Activities, even though such Claims may have been caused by any manner whatsoever, including but not limited to, the negligence, gross negligence, negligent rescue, omissions, carelessness, breach of contract and/or breach of any statutory duty of care of the Organization
g)  To FOREVER RELEASE AND INDEMNIFY the Organization from any action related to my becoming exposed to or infected by COVID-19 as a result of, or from, any action, omission or negligence of myself or others, including but not limited to the Organization
h)  That the Organization is not responsible or liable for any damage to my vehicle, property, or equipment that may occur as a result of the Activities
i)  That negligence includes failure on the part of the Organization to take reasonable steps to safeguard or protect me from the risks, dangers and hazards associated with the Activities
j)  This release, waiver and indemnity is intended to be as broad and inclusive as is permitted by law of the Province of Ontario and if any portion thereof is held invalid, the balance shall, notwithstanding, continue in full legal force and effect

Jurisdiction

7. I agree that in the event that I file a lawsuit against the Organization, I will do so solely in the Province of Ontario and further agree that the substantive law of the Province of Ontario will apply without regard to conflict of law rules.

I have read and agree to be bound by paragraphs 5 to 7

Medical Treatment Release

I, the undersigned parent or guardian, do hereby acknowledge, understand and agree that in participating in cheerleading/training, there is a possibility of physical injury/illness (both acute and permanent) and that my son/daughter is assuming risk of such injury/illness by his/her participation. I assume full responsibility for my son/daughter’s participation.  In order that my son/daughter/I may receive the necessary medical treatment in the event of injury or illness, I hereby authorize the Air Force Mavericks Gym Staff/Coaches to seek and/or facilitate medical treatment for my son/daughter for such illness or injury sustained during time in the gym. Furthermore, The Organization, its directors, officers, employees, volunteers, coaches, officials, business operators, and agents will not be held responsible for any injury or illness incurred while my son/daughter is in the gym.  

Border Crossing Consent

I, the parent/guardian of the participating Athlete am giving my full consent for my daughter/son to travel into the United States with The Organization and their Coaching Staff to participate in ALL of the season events for the duration of their participation in the program.  I give full responsibility for my daughter/son to the coaching staff of the Organization. 

Registration Contract

I have read the Air Force Mavericks Information package, the rules and regulations, pricing structure and understand it's contents.  I understand the responsiblity my Athlete is undertaking by becoming a registered member of The Organization.  I agree to fully suport the Athlete and will encourage them to fulfull their commitment.  

I also understand that by signing this contract, I am bound to not withhold my Athlete's participation in this program as a form of punishment as I realize that it also punishes their team and the entire Organization's program.  Furthermore, I understand that having an Athlete participate in The Organization is a commitment on the part of the parent/guardian as well.  I realize that when representing The Organization I will conduct myself with decorum and in a responsible manner.  I agree to refrain from inebriation as a result of alcohol or marijuana use when participating or attending any Organization affiliated event or in associated hotels or other event related spaces.

I understand that any Athlete or parent who does not abide by the rules and regulations contained in this contract, who is consistently negative, or acts in a manner that jeopardizes the name and reputation of The Organization and/or it's program, will be subject to removal with no refund.  

I have read and understood The Organization's Refund Policies and understand that should my Athlete leave the program outside of the refundable period, that I am responsible for all outstanding committed program costs as outlined in the published 2021-2022 Air Force Mavericks Information Package.  Failure to pay the account in full will result in the account being turned over to a collection agency.

Athlete's Acknowledgement of Responsibilities

The Athletes agrees to participate in the programme, related events and activities of The Organization

I the Athlete, understand and agree with the following statements:

a)  My parents and I believe that I am physically, emotionally and mentally able to fully participate in this programme and as such have given their unqualified permission for me to take part.

b)  I am familiar with, and will follow, all the applicable rules for participation in this programme.

c)  My equipment is mechanically fit and suitable for my use in this programme.

d)  I understand that at all times during my participation in this programme, I have sole responsibility for my safety.

e)  I understand that should I not attend the designated 'final four' practices leading up to a competition for any reason other than a family death or a severe and/or contagious illness, I will relinquish my right to compete at that competition and forfeight any competition costs. 

If, during the course of my participation in this programme:

a)  I learn or become aware, of a change in my health, physical, emotional or mental condition, or

b)  I feel unsafe or threatened for any reason, or

c)  I notice anything unsafe about the programme,

I will immediately STOP participating and inform the nearest AFM Team Member 

8. I acknowledge that I have read and understand this agreement, that I have executed this agreement voluntarily, and that this agreement is to be binding upon myself, my heirs, spouse, children, guardians, next of kin, executors, administrators and legal or personal representatives. I further acknowledge by signing this agreement I have waived my right to maintain a lawsuit against the Organization on the basis of any claims from which I have released herein.

Please sign here, and again on the pages that follow:

May 28, 2022

 

First Athlete's Name

First Name*

Last Name*

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

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent FIRST and LAST Name *

Primary Parent Mobile Phone Number *

Secondary Parent FIRST and LAST Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact FIRST and LAST Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
First Athlete's Signature*
Second Athlete's Name

First Name*

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

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent FIRST and LAST Name *

Primary Parent Mobile Phone Number *

Secondary Parent FIRST and LAST Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact FIRST and LAST Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Third Athlete's Name

First Name*

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

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent FIRST and LAST Name *

Primary Parent Mobile Phone Number *

Secondary Parent FIRST and LAST Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact FIRST and LAST Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Fourth Athlete's Name

First Name*

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

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent FIRST and LAST Name *

Primary Parent Mobile Phone Number *

Secondary Parent FIRST and LAST Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact FIRST and LAST Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Fifth Athlete's Name

First Name*

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

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent FIRST and LAST Name *

Primary Parent Mobile Phone Number *

Secondary Parent FIRST and LAST Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact FIRST and LAST Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Sixth Athlete's Name

First Name*

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

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent FIRST and LAST Name *

Primary Parent Mobile Phone Number *

Secondary Parent FIRST and LAST Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact FIRST and LAST Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Seventh Athlete's Name

First Name*

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

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent FIRST and LAST Name *

Primary Parent Mobile Phone Number *

Secondary Parent FIRST and LAST Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact FIRST and LAST Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Eighth Athlete's Name

First Name*

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

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent FIRST and LAST Name *

Primary Parent Mobile Phone Number *

Secondary Parent FIRST and LAST Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact FIRST and LAST Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Ninth Athlete's Name

First Name*

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

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent FIRST and LAST Name *

Primary Parent Mobile Phone Number *

Secondary Parent FIRST and LAST Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact FIRST and LAST Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
Tenth Athlete's Name

First Name*

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

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent FIRST and LAST Name *

Primary Parent Mobile Phone Number *

Secondary Parent FIRST and LAST Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact FIRST and LAST Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
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 join the Air Force Mavericks Mailing List
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. I am the legal guardian of the above athlete (or am a member that is 18 years of age). I verify that fee charts have been reviewed, explained and understood and I agree to pay all applicable team fees and agree to all terms stated in the payment and refund policies as outlined in the Air Force Mavericks Information Package.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

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

Participant Health Card Number
MEDICAL CONCERNS that staff should be aware of:*

If MEDICAL CONCERNS were identified above -- Please describe in detail:

Primary Parent FIRST and LAST Name *

Primary Parent Mobile Phone Number *

Secondary Parent FIRST and LAST Name

Secondary Parent Mobile Phone Number
Emergency Contact Person (check all that apply): *
Primary Parent
Secondary Parent
Other (please indicate below) :

Emergency Contact FIRST and LAST Name (if different from parent):

Emergency Contact Mobile phone (if different from parent) :
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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