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WAIVER FOR YOUTH UNDER AGE 18

 

XTRA INNINGS

3946 NW URBANDALE DRIVE

URBANDALE, IOWA  50322

(515) 528-2294

www.xtrainningsiowa.com

AGREEMENT AND RELEASE OF LIABILITY

This Agreement and Release of Liability ("Agreement") is given to and for the benefit of Xtra Innings Corporation ("Xtra Innings") and the employees, staff, volunteers, agents, contractors or other personnel of Xtra Innings Corporation (collectively, "Staff").

 

Youth Agreement

By signing this Agreement, I agree to abide by all Rules and Code of Conduct posted at the facility or provided to me by Xtra Innings.  I agree that the Rules and Code of Conduct may be changed by Xtra Innings.

I also agree to abide by the following during all activities at the facility:

  • I will respect the Staff, by listening and following their instructions to the group or to me personally.  I will respect others and their belongings.
  • I violate this Agreement, if, for example, I am disrespectful, disruptive, disorderly, using profanity or pornography, using or in possession of tobacco, alcohol or drugs, dressed inappropriately, being a danger to myself or to others, or involved in any behavior which could be demeaning to myself or others.
  • Any Staff may stop my participation in any activity, dismiss me from the facility, send me home or take other action if I violate this Agreement.
  • This Agreement applies to all activities offered by Xtra Innings.

​Please type your son or daughter's name in the signature box to indicate agreement.

September 17, 2021

 

Parent/Guardian Agreement

By signing this Agreement:

  • I state that I am the parent or authorized legal guardian of the named child.
  • I give my permission for my child to attend and participate in all activities at or offered by Xtra Innings, including participating in all baseball or softball activities, such as batting cages; pitching tunnels; batting, pitching, catching or throwing lessons; video training; virtual reality training, practices; games; and other activities.
  • I have read the Registration Form and the agreement of my child. I understand that Staff may act on the agreement by my child as they decide in each case. If my child is sent home, I am responsible for picking up my child and all costs.
  • I authorize Xtra Innings and its Staff to provide or approve medical treatment for my child. I will be responsible for all costs and expenses of any medical treatment. I also understand, however, that neither Xtra Innings nor any Staff are required to provide or approve any medical treatment.
  • I may be financially responsible for repairs and/or replacement of equipment within Xtra Innings if I am found to be careless, destructive, and/or negligent in using the equipment.
  • I consent to the use by Xtra Innings of any videos, photographs and other images of my child in any promotional or other materials of Xtra Innings, including in print, via TV or the Internet or in any form of social media.

In addition:

I understand that the activities and programs of Xtra Innings involve various risks, including sickness or emotional or physical injury, which could be serious, or death, and loss of or damage to property. There are also risks that cannot be foreseen.  I also understand that there may be other participants in activities, and that Xtra Innings is not responsible for any actions or statements by others. I understand I may catch a virus or other illness, or otherwise become sick, from Staff or other participants or from using gear, equipment or other facilities used by Staff or other participants. I accept all known and unknown risks.

Also:

I fully waive and release Xtra Innings and its Staff from any and all liability and suits, actions, proceedings or claims (of any type) for any sickness or injuries to me or my child, loss of life, loss of or damage to any of our property or any other liabilities, claims, losses or damages.  My release includes any sickness, injury, death, loss or damage in any way caused by any medical treatment provided by Xtra Innings, by the condition of the facilities, or by any negligence, recklessness or other act or omission of Xtra Innings, any Staff or any participant in any activities. I understand this is a full and complete waiver of all legal rights. This waiver and release are additional and cumulative to any other waivers or releases that I or another parent or guardian may at any time give for my child.

Please select who will be participating in activities at Xtra Innings....
Minor(s)
1 Minor2 Minors3 Minors4 Minors5 MinorsMore Minors6 Minors7 Minors8 Minors9 Minors10 Minors
Continue
First Customer Name

First Name*

Last Name*

Phone*
First Customer Date of Birth*
First Customer Medical Information

Please list any allergies, medical alerts, prescription medications or other health information
Is minor covered by medical insurance?*
No
Yes

If yes, name of insurance company.

Policy or Group Number
First Customer Signature*
Second Customer Name

First Name*

Last Name*
Second Customer Date of Birth*
Second Customer Medical Information

Please list any allergies, medical alerts, prescription medications or other health information
Is minor covered by medical insurance?*
No
Yes

If yes, name of insurance company.

Policy or Group Number
Third Customer Name

First Name*

Last Name*
Third Customer Date of Birth*
Third Customer Medical Information

Please list any allergies, medical alerts, prescription medications or other health information
Is minor covered by medical insurance?*
No
Yes

If yes, name of insurance company.

Policy or Group Number
Fourth Customer Name

First Name*

Last Name*
Fourth Customer Date of Birth*
Fourth Customer Medical Information

Please list any allergies, medical alerts, prescription medications or other health information
Is minor covered by medical insurance?*
No
Yes

If yes, name of insurance company.

Policy or Group Number
Fifth Customer Name

First Name*

Last Name*
Fifth Customer Date of Birth*
Fifth Customer Medical Information

Please list any allergies, medical alerts, prescription medications or other health information
Is minor covered by medical insurance?*
No
Yes

If yes, name of insurance company.

Policy or Group Number
Sixth Customer Name

First Name*

Last Name*
Sixth Customer Date of Birth*
Sixth Customer Medical Information

Please list any allergies, medical alerts, prescription medications or other health information
Is minor covered by medical insurance?*
No
Yes

If yes, name of insurance company.

Policy or Group Number
Seventh Customer Name

First Name*

Last Name*
Seventh Customer Date of Birth*
Seventh Customer Medical Information

Please list any allergies, medical alerts, prescription medications or other health information
Is minor covered by medical insurance?*
No
Yes

If yes, name of insurance company.

Policy or Group Number
Eighth Customer Name

First Name*

Last Name*
Eighth Customer Date of Birth*
Eighth Customer Medical Information

Please list any allergies, medical alerts, prescription medications or other health information
Is minor covered by medical insurance?*
No
Yes

If yes, name of insurance company.

Policy or Group Number
Ninth Customer Name

First Name*

Last Name*
Ninth Customer Date of Birth*
Ninth Customer Medical Information

Please list any allergies, medical alerts, prescription medications or other health information
Is minor covered by medical insurance?*
No
Yes

If yes, name of insurance company.

Policy or Group Number
Tenth Customer Name

First Name*

Last Name*
Tenth Customer Date of Birth*
Tenth Customer Medical Information

Please list any allergies, medical alerts, prescription medications or other health information
Is minor covered by medical insurance?*
No
Yes

If yes, name of insurance company.

Policy or Group Number
Customer 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 more from Xtra Innings!
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
I have reviewed and considered this Agreement before signing it. This Agreement shall bind my child, any other parents or guardians of my child, and my heirs and representatives. This Agreement sets out our entire agreement, and this Agreement cannot be changed except in a writing that is signed by Xtra Innings. ​
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

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

Please list any allergies, medical alerts, prescription medications or other health information
Is minor covered by medical insurance?*
No
Yes

If yes, name of insurance company.

Policy or Group Number
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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