Boston Bolts UV Registration Form
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Player's Legal First Name *
Player's Legal Last Name *
Date of Birth (mm/day/year) *
Player's Street Address *
Player's City, State, Zip Code *
Parent #1 Name (First & Last) *
Parent #1 Cell Phone *
Parent #1 Email *
Parent #2 Name (First & Last)
Parent #2 Cell Phone
Parent #2 Email
T-shirt Size *
ACKNOWLEDGEMENT OF RISK AND AGREEMENT:In consideration of being allowed to participate in Boston Bolts Upper Valley practices, games, and training sessions, both group and individual, tournaments and any other related events and activities, THE PARTICIPANT and his/her PARENT/GUARDIAN acknowledges, appreciates, and agrees that:  1) The risk of activities involved in the program is real and can be considerable, including the potential of permanent paralysis or death, and while rules, equipment, and personal discipline may reduce risk, the risk of serious injury does exist; and,     2) The participant and his/her parent/guardian KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assumes all full responsibility for participation; and,    3) Kimball Union Academy does not operate/run this Club. The participant and his/her parent guardian agree TO RELEASE Kimball Union Academy/Boston Bolts Upper Valley, its trustees, officers, employees, volunteers, members, and representatives from all liabilities and claims whatsoever arising out of, or in connection with THE PARTICIPANTS’ attendance and participation in the Boston Bolts Upper Valley, even those that may have been caused by the ordinary negligence of Kimball Union Academy.      4) The participant and his/her parent guardian have read this form in its entirety and understand by signing this form, they are giving up legal rights and remedies on behalf of the program participant, and his/her family, estate, heirs and/or assigns. Via signature below they HEREBY RELEASE AND HOLD HARMLESS Boston Bolts Upper Valley, CM International LLC and Kimball Union Academy, their officers, members, owners, licensees, officials, contractors, agents and/or employees, other participants, host clubs/organizations, sponsors, advertisers and if applicable, owners and lessors of premises used to conduct the program and any other events (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM NEGLIGENCE OF THE RELEASEES OR OTHERWISE. The participant and his/her parent guardian HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT THEY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT. *
SUSPENSION OR DISMISSAL FROM CLUB: The participant and his/her parent/guardian agree that he/she will follow all relevant club directions, rules, and policies and will obey coach directions, and acknowledge that the Team Coordinator has the right to suspend or remove the player from participation in the Club at any time for violation of club or team policies. *
MEDIA RELEASE: Boston Bolts Upper Valley may make and use images, video, and audio recordings of the participant, and take and use quotes or statements from the participant. THE PARTICIPANT (or parent/guardian) releases all claims against Boston Bolts Upper Valley with respect to privacy, copyright ownership, and publication related to the use of the quotes, images, or recordings *
Electronic Signature - indicating I have read and agree to the above: *
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