Athlete Waiver Form 2019-2020
Welcome to the AHA Athlete Waiver Form!
Please complete the form below and hit 'Submit' at the end. Thank you for registering.
Email address *
Athlete's Last Name *
Your answer
Athlete's First Name *
Your answer
Date of Birth *
MM
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DD
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Gender *
T-Shirt Size *
Home Address *
Your answer
School District *
Your answer
School Currently Attending
*Only required if still in school
Your answer
Willing to travel to other school districts? *
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Phone Number *
Your answer
Family Physician First and Last Name *
Your answer
Physician's Phone Number *
Your answer
Has your child ever experienced or is currently being treated for any of the following? *
Required
Does your child wear any of the following?
Policy Holders First Name *
Your answer
Policy Holders Last Name *
Your answer
Insurance Company *
Your answer
Policy Number *
Your answer
Tell us a little bit about your child and his/her abilities. Please also include any helpful tips for working with them. *
Your answer
By checking in the box below, I agree to the terms described in the Athletes Helping Athletes, Inc. Scholastic Waiver Form.This Waiver Form is valid for the entire 2019-20 Calendar School Year of Games and Events. *
SCHOLASTIC YEAR WAIVER FORM I/We, the parents and/or legal guardian of the Participant, a minor, hereby give our consent for the above named individual to participate in the activities sponsored by Athletes Helping Athletes Inc. during the Scholastic Year from August 15, 2019 through June 30, 2020 and hereafter agree to the following terms and conditions related to his/her participation. I/We give my/our permission to engage in all activities except as noted on the back of this form. I/We understand that I/We am/are responsible for arranging this young person's transportation to and from the event (even if dismissed prior to the official end of the event because of unruly behavior or other circumstances). Athletes Helping Athletes Inc. and all of its participating schools and organizations shall not be responsible for the safety, health or well- being of any individual, parent and/or legal guardian of any Participant and/or any other Participant.In case of medical emergency, I/We understand that it is very important for me/us to stay inside the building at all times during the event. If for some reason I/We cannot be found or reached, I/We hereby authorize and consent to any x-ray, examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any licensed medical personnel on the staff of any licensed hospital. This authorization is given in advance of any specific diagnosis, treatment or hospital care required, but is given to provide authority and power to render care, which is deemed advisable in the best judgment of the physician. I/We agree to be solely responsible for paying for all fees, costs, charges related to any of the aforesaid health care, diagnosis and/or treatment including but not limited to all medical, surgical, hospital, ambulance or any other health care or other provider.I/We hereby agree to indemnify, defend and hold harmless Athletes Helping Athletes Inc. and the above entity, their officers, directors, members, employees, volunteers, successors and assigns from and against all losses, liabilities, claims, demands, causes of action, damages, costs, including reasonable attorney’s fees and expenses of every kind and nature arising out of or resulting from or caused by in whole or in part any act, omission, negligence or fault of Athletes Helping Athletes Inc. and the above entity, their officers, directors, members, employees, volunteers, successors and assigns in connection with Participant’s participation in the event including but not limited to those in connection with the loss of life, bodily injury, personal injury, damage to property as well as in connection with any health care expenses including but not limited to all medical, surgical, hospital, ambulance or any other health care or other provider. This obligation to indemnify, defend and hold harmless Athletes Helping Athletes Inc. and the above identified entity, their officers, directors, members, employees, volunteers, successors and assigns shall survive the termination of this agreement.By signing this agreement, I allow Athletes Helping Athletes Inc. to use their discretion when sharing any photographs/videos in both print and social media.
Required
Date Signed *
MM
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Type Signature *
Full Name
Your answer
Submit
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