Jus' Ryde Track - 2019 Club Registration
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Name: Athlete (First )
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Name: Athlete (Last)
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Parent Name: (First Last)
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Parent Name:
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Emergency Contact #1: Name, Phone Number
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Emergency Contact #2: Name, Phone Number
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Allergies:
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Medical Conditions:
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Medications:
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Jus’ Ryde Track Club Release and Waiver of Liability and Indemnity Agreement (Read Carefully Before Signing)
In consideration of being permitted to participate in any way in the Jus’ Ryde Track Club Program indicated below and/or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), the parent(s) and/or legal guardians(s) of the minor participant named below agree: 1. The parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating in any Jus’ Ryde Track Club activity or event, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I understand and agreed that, if at any time, I feel anything to be UNSAFE, I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further, 2. I/We fully understand and acknowledge that: • There are risks and dangers associated with participation in Jus’ Ryde Track Club events and activities which could result in bodily injury, partial and/or total disability, paralysis and death; • The social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe; • These risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to, the Releasees named below; and • There may be other risks not known to us or are not reasonably foreseeable at this time. 3. I/WE accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of the Releasees named below. 4. I/WE HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the Jus’ Ryde Track Club, Polk County School Board, and the City of Lakeland facilities used by the participant, including its owners, managers, coaches, promoters, lessees of premises used to conduct the Jus’ Ryde Track Club events or programs, premises and event inspectors, underwriters, consultants and others who give recommendations, directions, or instructions to engage in risk evaluation or loss control activities regarding the Jus’ Ryde Track Club facility or events held at such facility and each of them, their directors, officers, agents, employees, all for the purposes herein referred to as “Releasee” ...FROM ALL LIABILITY TO THE UNDERSIGNED, my/our personal representative, assigns, executors, heirs and next to kin FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES OR DAMAGES AND ANY CLAIMS OR DEMANDS THEREFORE, ON ACCOUNT OF ANY INJURY, INCLUDING BUT NOT LIMITED TO THE DEATH OF THE PARTICIPANT OR DAMAGE TO PROPERTY, ARISING OUT OF OR RELATING TO THE EVENT(S) CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEE OR OTHERWISE. 5. I/WE HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death and/or property damage. Each of THE UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES. 6. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the event is conducted and that any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect. 7. On behalf of the participant and individually, the undersigned parent(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. Type name below if you agree:
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Medical Treatment Consent
medication during the course of his/her attendance or participation in the Jus’ Ryde Track Club, I authorize such physicians or medical staff as the organizers of this activity may appoint or designate to carry out the necessary treatment, or to take my child/ward to the emergency room of the nearest hospital, and I further authorize the hospital and its medical staff to provide treatments deemed necessary by them for the well being of my child/ward. It is understood, however, that if hospitalization or treatment of a more serious nature is required, I will be contacted, if at all possible by telephone for permission. Type name below if you agree:
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Media Consent
I hereby grant permission for the employees of the Jus’ Ryde Track Club to record my child’s likeness for use by television, film, radio or printed media to further the aims of those activities and programs in related campaigns, social media, magazine articles, booklets, posters, and in any other ways they may see fit. I hereby release them from any and all claims in its usage. Type name below if you agree:
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