Kevics Junior Academy Meet & Greet Request Form
Please complete the following form and submit it. Someone from our staff will be in touch with you shortly to schedule a Meet & Greet with you. Thank you.
Parent/Guardian First & Last Name *
This field will be accepted as your legal electronic signature for this form upon it's submission.
Your answer
Parent/Guardian Relation to Candidate *
Your answer
Phone Number *
ex: 9998887777
Your answer
Email Address *
Your answer
City of Residence *
Your answer
State of Residence *
Your answer
Program of Interest *
What is the best time for us to call you? *
Candidate's First Name *
Your answer
Candidate's Last Name *
Your answer
Candidate's Age *
Your answer
Candidate's Gender *
Candidate's Handedness *
How much experience does the Candidate have? *
Your answer
How did you hear about us? *
Please let us know how you found us. If it was through someone specific, please put down their name, as we like to thank our loyal patrons.
Your answer
Please provide any other information about the Candidate that you think would be helpful to us.
Your answer
Waiver of Liability *
In consideration of being allowed to participate in any way in the services provided by Kevics LLC, Bob Moore’s Sport Center, any golf course, other facilities, and the staff, employees, independent contractors (collectively known as Service Providers) related events and activities, I, the undersigned, acknowledge, appreciate and agree that: 1. The risk of injury from the activities involved in these sport events is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and 2. I knowingly and freely assume all such risks, both known and unknown, and assume full responsibility for participation of The Member; and 3. I willingly agree to comply with the stated instructions and policies and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during the presence or participation of The Member, I will remove The Member from participation and bring such to the attention of the Service Providers immediately; and 4. I understand that if The Member is to be a passenger in any form of vehicle while traveling to and/or from or during any Service Providers related activities, I assume all liability insurance coverage; and 5. I, for The Member and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify and hold The Service Providers, and their officers, officials, agents and/or employees, other sport participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event or activity (“Releases”) harmless with respect to any and all injury, disability, death, or loss or damage to person or property, to the fullest extent permitted by law. Do you agree that you've read and accept the Waiver of Liability statement?
Assumption of Risk *
I understand, agree and acknowledge that some activities may be of a hazardous nature and/or include physical and/or strenuous activity. Understanding this, I state that The Member has no medical condition or impairment that might inhibit safe and active participation in the services provided. In addition, I understand that the Service Providers do not provide medical insurance coverage for service participants and that any applicable medical insurance must be provided individually by such participants. In the case of injury or medical emergency and in the event participant, or their parent or guardian, cannot respond at the time of the emergency, the Service Providers have permission to seek, administer, or have administered whatever first aid or emergency medical care deemed necessary for participant’s welfare, and it is understood that participant, and not the Service Providers, shall be responsible for any and all charges for such health care services regardless of whether participant’s medical insurance would cover such charges. Do you agree that you've read and accept our Assumption of Risk statement?
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