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Liability Release & Medical Waiver Form Appearance Agreement
For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I (Parent Guardian Name) , as parent or legal guardian of (Minor Name) a minor (hereinafter "Minor"), hereby grant the permission necessary to allow Minor to participate in the activities associated with the R&B Training Center, Inc (hereinafter "Program") to be administered by R&B Training Center, Inc. I acknowledge and agree, in my own behalf and on behalf of the Minor, that such participation subjects the Minor to the possibility of psychical illness or injury (minimal, serious, catastrophic and/or death) and that I, in my own behalf and on behalf of the Minor, acknowledge that the Minor is assuming the risk of such illness or injury by participating in the Program. In the event of such illness or injury, I authorize R&B Training Center, Inc. to obtain the necessary medical treatment for the Minor and hereby, in my own behalf and on behalf of the Minor, release and hold harmless R&B Training Center, Inc., the Hosting site, on whose premises the Program will occur, the affiliates and staff R&B Training Center, Inc. and the Hosting site and their respective affiliates (hereinafter Collectively "Releasees") in the exercise of this authority I further acknowledge and agree that I will be responsible for any and all medical and related bills that may be incurred on behalf of the Minor for any illness or injury that the Minor may sustain during the Program and while traveling to and from the site for the Program whether or not the Program actually occurs.

I, in my own behalf and on the behalf of the Minor, further agree to release and to hold harmless Releasees from any and all liability for negligence or any other claim, judgment, loss, liability, cost and expenses *Including without limitations attorney's fees and costs) arising out of or connected with the Program, including any claim arising out of or connected with and illness or injury that the Minor may incur or sustain during the Program, all activities associated with the Program and while traveling to and from the site for the event whether or not the Program actually occurs. I further expressly agree to indemnify and hold harmless Releasees and Releasee's heirs, successors, assigns, executors and administrators against loss from any further claims, demands or actions that may subsequently be brought by Minor or by any other person or persons on account of damages of any character resulting to Minor in any way from the foregoing activities. I further agree to reimburse and to make good to Releasees any loss, damages or costs Releasees may have to pay as a result of any such action, claim or demand.

Appearance Agreement: I understand that R&B Training Center, Inc. from time to time produces promotional material relating to its programs. I understand that as a participant in and/or a spectator at the Program the Minor may be included in videotapes or photographs taken during the Program. Therefore, within reservation or limitations, I, in my own behalf and on behalf of the Minor, hereby assign, transfer and grant R&B Training Center, Inc. their successors, assignees, licenses, sponsors, and television networks, and all other commercial exhibitors the exclusive right to photograph and/or videotape the Minor and to utilize such videotapes and photographs and Minor's name, face, likeness, voice and appearance as part of the Program, in advertising and promoting the Program or in advertising and promoting similar future events. I further understand that R&B Training Center, nor any other party i sunder any obligation to exercise any of the foregoing rights, licenses and privileges.

I represent that any medication to which the Minor is allergic or is currently taking are listed below. I agree that Minor shall bring medications, which Minor is currently taking with him/her to the Event and that he/she shall consume the prescribed dosage when appropriate. Any medications prescribed for illness or injury must take into consideration the practice and performance environment. Your doctor must communicate any medication that potentially hinders athletic performance, as it pertains to this activity, to the coaching staff in writing.

I, in my own behalf and on behalf of the Minor, hereby warrant that I have read the Release and Waiver in it's entirety and fully understand it's contents. I, in my own behalf and on behalf of the Minor, am aware that this Release and Waiver releases Releasees from liability and contains an acknowledgement of my voluntary and knowing assumption of the risk of injury or illness. I, in my own behalf and on the behalf of the Minor, further acknowledge that nothing in this Release and Waiver constitutes a guarantee that the Program will occur. I, in my own behalf and on behalf of the Minor, have signed the document voluntarily and of my own free will.

I do hereby verify that I full understand and accept the preceding conditions for permitting participation to participate in and attend the R&B Training Center Programs.

I, Identified above as Minor, acknowledged that I have read and understand this Release and Waiver form.
Participants Last Name: *
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First Name: *
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Age: *
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Level: *
Grade (upcoming school year): *
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Male/Female: *
Parent's Last Name: *
Your answer
First Name: *
Your answer
Home Phone #: *
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Work Phone #:
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Cell Phone #:
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Address: *
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City: *
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State: *
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Zip: *
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Primary Emergency Contact: *
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Primary Emergency Phone #: *
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Primary Emergency Phone #:
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Other Emergency Contacts/Numbers:
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Parent Email Address: *
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Medications:
Your answer
Allergic to (if any)
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Medical Condition(s) Previous Injuries:
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Family Doctor: *
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Phone: *
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Dentist Phone #:
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Medical Insurance: *
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Plan ID # *
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Policy #: *
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Subscriber: *
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Nationwide 800#:
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Parent/Guardian Electronic Signature: *
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Participant's Electronic Signature: *
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Date: *
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