Loading...

Participation waiver and consent

ATTENTION: PLEASE READ CAREFULLY BEFORE SIGNING.

To: Primal Athletics, its employees, officials, officers, directors, volunteers, contractors, sponsors, representatives, the owner of the facilities in which Primal Athletics operates (the “Facilities”), the operator of the Facilities, and any other businesses or tenants that operate in the Facilities (collectively, the “Released Parties”)

As a Participant of on and off ice activities at the Facilities (the “Programs”), I fully understand and agree to the following:

Assumption of Risks: In consideration of my participation in the Programs, I understand the nature of such programs and I confirm that I am qualified, in good health and proper physical condition to participate in the Programs. I acknowledge that the Programs may result in personal injury and involve various risks, dangers and hazards which all participants are required to assume, including but not limited to: Muscular injuries, soft tissue injuries, broken bones, bruises, scrapes, cuts, sprains, dislocation, head injuries, facial injuries, eye injuries, dental injuries, or injuries resulting from walking, running, slipping and/or falling, and injuries or illness resulting from failure to follow directions from those in charge of the Programs and all related activities.

I hereby freely accept and fully assume all such risks, dangers and hazards and the possibility of personal injury or loss resulting from my participation in the Programs.

Consent to medical treatment: I hereby give permission for Primal Athletics or its affiliates to arrange for any emergency medical care including hospitalization, transportation, and the administration of medical treatment as may be deemed necessary in the circumstances. I agree to pay all costs associated with my medical care and transportation.

Release: In consideration of being granted permission to participate in the Programs, I hereby for myself and my heirs, executors, administrators or any others who may claim on my behalf, agree and covenant not to sue, and hereby waive, release and discharge Primal Athletics and the Released Parties from any and all claims of liability for personal injury, illness, loss of life or property damage of any kind or nature, arising out of or sustained by my attendance at the Facilities and/or in the course of my participation in the Programs.

Indemnity: In consideration of being granted permission to participate in the Programs, I agree to hold harmless and indemnify Primal Athletics and the Released Parties from any and all liability, loss, claims, demands, costs and expenses, including reasonable legal fees, due to any personal injuries or property damage to any third party arising from my attendance at the Facilities and/or participation in the Programs.

Personal Information: I consent to the collection, use and disclosure of my personal information and am aware that the following personal information may be collected before, during or after the Programs by Primal Athletics and its affiliates, including but not limited to:

Names of participants and guardians, addresses, phone numbers, ages, and birth dates of participants, and details about the Programs attended by participants; and Photographs and videos of participants while participating in the Programs.

I consent to the collection, use and disclosure of my personal information obtained as a result of my attending the Facilities and/or my participation in the Programs and acknowledge that my personal information may be used for purposes including, but not limited to, facilitating the Programs, marketing the Programs, outreach activities to the general public, use in print and digital marketing, promotion and public relations material, display on Primal Athletics’ website and social media sites, collection of fees, and for recruitment initiatives.

I AM AWARE OF THE NATURE AND EFFECT OF THIS WAIVER, MY ASSUMPTION OF RISKS, CONSENT TO MEDICAL TREATMENT, RELEASE, INDEMNITY AND CONSENT TO THE COLLECTION AND USE OF MY PERSONAL INFORMATION. I FULLY UNDERSTAND THE TERMS OF THIS WAIVER AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

TODAYS DATE: November 30, 2022

First Participant's Name

First Name*

Middle Name

Last Name*
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*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!