Francis Cornejo Volleyball Camp    

807 Pointer Ridge Drive, Gaithersburg, MD 20878

Tel 240-446-7371

PLAYER__________________________________________________________________   

                                LAST NAME                                 FIRST                                   MIDDLE

WAIVER, RELEASE AND INDEMNITY AGREEMENT FORM

 

I understand that there are risk and danger inherent in participating and / or receiving instruction to participate and or receive instruction in this sport or activity during the said Camp/Clinic. I must give up my rights to hold Francis Cornejo, its coaches, instructors and all event sites liable for any inquiry or damage, which I may suffer while participating and/or receiving instruction in this sport activity. I understand  and agree to assume all medical, psychological and mental risk in connection with participating and / or receive instructions in camp/clinic; where foreseen or unforeseen; and all event sites from any claim by me or my family, estate heirs or assigns, arising out of my participating and/or receiving instructions in this camp/clinic.I have medical  health insurance to cover all expenses involve in this agreement.

 

Knowing this and in consideration of being permitted to participate and/or receive instructions in this sport or activity, I hereby voluntarily release Francis Cornejo, its coaches and instructions and all even sites from an and all liability resulting from or arising out of my participating and or receiving instruction in volleyball, and hereby personally assume all risk in connection with participating and / or receive instructions in camp/clinic; where foreseen or unforeseen; and all event sites from any claim by me or my family, estate heirs or assigns, arising out of my participating and/or receiving instructions I this camp/clinic.

  1. I understand and agree that I am releasing not only the entities set forth in the paragraph above, but also the officers, agents and employees of those entities,
  2. I understand and agree that this Agreement applies to personal injury, property   damage or wrongful death, which I may suffer, even if caused by the act or omission of others, 
  3. I consent to Francis Cornejo’s Volleyball Camp the use of photograph and Videotapes made of volleyball lessons for advertising their volleyball program   

I ACKNOWLEDGE THAT I HAVE READ THIS AGREEMENT AND THAT I UNDERSTAND THE WORDS AND LANGUAGE IN IT. I HAVE BEEN ADVISED OF THE POTENTIAL DANGERS INCIDENTAL TO PARTICIPATE AND/OR RECEIVE INSTRUCTION IN SAID SPORT OR ACTIVITY. THIS AGREEMENT SHALL BE CONSTRUED UNDER AND IN ACCORDANCE WITH THE LAWS OF THE STATE OF MARYLAND.

 

HOME ADDRESS ____________________________________CITY_______________ STATE _____________  ZIP ________________

 

PARENT / GUARDIAN RELEASE. I am the parent or / legal guardian of the above minor__________________________and I am signing this document on behalf of said minor.

 PRINT NAME (PARENT or GUARDIAN) _____________________________________

SIGNATURE (PARENT or GUARDIAN) _____________________________________