Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

2011 street games participants waiver

388 views

Published on

PARTICIPANT WAIVER
Street Games™ Presented by the Jon Drummond Achievement Foundation
Saturday, September 17, 2011

Published in: Sports
  • Be the first to comment

  • Be the first to like this

2011 street games participants waiver

  1. 1. PARTICIPANT WAIVER Street Games™ Presented by the Jon Drummond Achievement Foundation Saturday, September 17, 2011 Please PrintParticipant’s Full Name __________________________________ Date of Birth ___/___/_____ Age_______Child’s Height ________ Weight _________ Home Phone ____________Guardian Cell# ____________________Address ____________________________________/ _______________________________/ ____ / _______ Street City State Zip(PARTICIPANT’S NAME)__________________________________IS FIT ENOUGH TO PARTICIPATE IN THEACIVITIES OF Street Games AND HAS MY PERMISSION TO PARTICIPATEGUARDIAN/CHAPERONE SIGNATURE______________________________________________________________Name of Guardian/Chaperone___________________________________________________________________Child’s Release: In consideration of your acceptance of my entry into the Street Games, I voluntarily agree to participate in the 2011 StreetGames and knowingly assume any and all risk of loss, damage, property loss, injury (including death), both foreseen and unforeseen, of myattendance at and participation in the Street Games, from any cause whatsoever. I, for myself, my heirs, personal representatives and assignsdo hereby release, waive, discharge and covenant not to sue Jon Drummond, the Jon Drummond Achievement Foundation, the Street Games,the owner or lessee of any facility in which the Street Games are held (collectively “Releases”) from all liability, loss, claims, demands,possible causes of action, court costs, settlement costs and fees, attorneys fees and any other expenses arising from any claim or lawsuit thatmay arise from any loss, damage or injury (including death) to me or my property resulting from or arising in connection with, or related to, myattendance at or participation in the STREET GAMES. I/we grant permission to the Meet Directors or their designee or the assignedChaperones of any Street Games, competition or program to act as guardian/spokesman with full authorization and power to authorizeemergency medical treatment, including hospitalization and anesthesia, if medically necessary, for my/our son or daughter while in routeto/from or at the site of the Street Games, competition or program. I/we understand that should a health emergency arise, I/we will be notifiedbut if/we cannot be reached by phone such medical treatment as is deemed necessary by medical personnel under the circumstancespresented is hereby expressly authorized. PARTICIPANT WAIVER Street Games™ Presented by T the Jon Drummond Achievement Foundation Saturday, September 17, 2011 Please PrintParticipant’s Full Name __________________________________ Date of Birth ___/___/_____ Age_______Child’s Height ________ Weight _________ Home Phone ____________Guardian Cell# ____________________Address __________________________________/ _______________________________/ ____ / ________ Street City State Zip(PARTICIPANT’S NAME)__________________________________IS FIT ENOUGH TO PARTICIPATE IN THEACIVITIES OF Street Games AND HAS MY PERMISSION TO PARTICIPATEGUARDIAN/CHAPERONE SIGNATURE______________________________________________________________Name of Guardian/Chaperone___________________________________________________________________Child’s Release: In consideration of your acceptance of my entry into the Street Games, I voluntarily agree to participate in the 2011 StreetGames and knowingly assume any and all risk of loss, damage, property loss, injury (including death), both foreseen and unforeseen, of myattendance at and participation in the Street Games, from any cause whatsoever. I, for myself, my heirs, personal representatives and assignsdo hereby release, waive, discharge and covenant not to sue Jon Drummond, the Jon Drummond Achievement Foundation, the Street Games,the owner or lessee of any facility in which the Street Games are held (collectively “Releases”) from all liability, loss, claims, demands,possible causes of action, court costs, settlement costs and fees, attorneys fees and any other expenses arising from any claim or lawsuit thatmay arise from any loss, damage or injury (including death) to me or my property resulting from or arising in connection with, or related to, myattendance at or participation in the STREET GAMES. I/we grant permission to the Meet Directors or their designee or the assignedChaperones of any Street Games, competition or program to act as guardian/spokesman with full authorization and power to authorizeemergency medical treatment, including hospitalization and anesthesia, if medically necessary, for my/our son or daughter while in routeto/from or at the site of the Street Games, competition or program. I/we understand that should a health emergency arise, I/we will be notifiedbut if/we cannot be reached by phone such medical treatment as is deemed necessary by medical personnel under the circumstancespresented is hereby expressly authorized.

×