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NATIONWIDE FOOTBALL CAMPS....

FOR GIRLS!

ages 6-18

OCTOBER 12TH, 2024

Registration Closes
OCT 5th!

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GOT HER BACK GIRLS FOOTBALL CLINIC

Participant First Name

Participant Last Name

How old is the participant?

Participant Phone #

Participant Email

Address

City

State

Zip Code

Parent or Guardian First Name

Parent or Guardian Last Name

Parent or Guardian Email

Emergency Contact Name (if Parent or Guardian cannot be reached)

Parent or Guardian Phone #

Emergency Contact Ph #

What is the football experience level of the participant?

Is this the first time attending a football camp?

Yes

WAIVER & RELEASE FORM
PARTICIPANT RELEASE OF LIABILITY

IF YOU ARE UNDER 18, YOUR PARENT OR LEGAL GUARDIAN MUST SIGN THIS WAIVER. READ IN ENTIRETY BEFORE SIGNING.

In consideration for my child or ward,____________________________________ being allowed to participate in any way in GOT HER BACK, INC. events and activities, the undersigned acknowledges, appreciates, and agrees that:

1. The risk of injury from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury to my child or ward does exist; and,

2. I, on behalf of myself and my child or ward, knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees (as defined in paragraph 4 below) or others, and assume full responsibility for my child or ward’s participation; and,

3. I willingly agree to comply with and to make my child or ward abide by the stated and customary rules, terms and conditions for participation. If I or my child or ward observe any unusual significant concern in his/her readiness for participation and/ or in the program itself, either my child or ward or I will remove him/her from participation and bring such to the attention of the GOT HER BACK, INC. front office immediately; and,

4. I, FOR MYSELF AND ON BEHALF OF MY CHILD OR WARD AND OUR HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES AND NEXT OF KIN, HEREBY RELEASE, INDEMNIFY AND HOLD HARMLESS GOT HER BACK, INC., AND THEIR OFFICERS, ELECTED OFFICIALS, AGENTS, EMPLOYEES, OTHER PARTICIPANTS, SANCTIONED EVENTS, SANCTIONED ORGANIZATIONS, SPONSORING AGENCIES, SPONSORS, ADVERTISERS, AND IF APPLICABLE, OWNERS AND LESSORS OF GOT HER BACK, INC., FROM ANY AND ALL CLAIMS ARISING OUT OF MY PRESENCE AT ANY GOT HER BACK, INC. EVENT, INCLUDING, BUT NOT LIMITED TO, CLAIMS FOR ANY AND ALL INJURIES, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, TO THE FULLEST EXTENT PERMITTED BY LAW, INCLUDING ATTORNEY’S FEES AND ATTORNEY’S FEES ON APPEAL.

I have read this release of liability and assumption of risk agreement, reviewed it with my child or ward and we fully understand its terms, understand that we have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.

I have read this release of liability and assumption of risk agreement, and fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement.

I certify that I am 18 years of age and that I am entering into this agreement and the Medical Release as the parent or legal guardian for the minor Participant named above and that I also have the authority to do so on behalf of the Participant’s other parents or guardians.

MEDICAL RELEASE:

In the event that I am unable to be reached in an emergency, I hereby give permission for medical treatment, and related transportation, to any licensed physician, surgeon, clinic, hospital, or ambulance service to secure proper treatment, for my child as named above.

Please list any allergies and medical conditions that should be brought to our attention. Include any medication(s) that your child uses regularly. If none, please indicate that below:

Date:

SIGNATURE of Participant OR Signature of Parent or Legal Guardian (if participant is a minor):

VIDEO/PHOTOGRAPH RELEASE FORM

I hereby grant GOT HER BACK, INC. the irrevocable right and permission to use photographs and/or video recordings of me on websites and in publications, promotional flyers, educational materials, derivative works, or for any other similar purpose without compensation to me.

I understand and agree that such photographs and/or video recordings of me may be placed on the Internet. I also understand and agree that I may be identified by name and/or title in printed, Internet or broadcast information that might accompany the photographs and/or video recordings of me. I waive the right to approve the final product. I agree that all such portraits, pictures, photographs, video and audio recordings, and any reproductions thereof, and all plates, negatives, recording tape and digital files are and shall remain the property of GOT HER BACK, INC.

I hereby release, acquit and forever discharge GOT HER BACK, INC., its current and former trustees, agents, officers and employees of the above-named entities from any and all claims, demands, rights, promises, damages and liabilities arising out of or in connection with the use or distribution of said photographs and/or video recordings, including but not limited to any claims for invasion of privacy, appropriation of likeness or defamation.

I hereby warrant that I am eighteen (18) years old or more and competent to contract in my own name or, if I am less than eighteen years old, that my parent or guardian has signed this release form below. This release is binding on me and my heirs, assigns and personal representatives.

Printed Name of Individual Photographed/Recorded

Signature of Individual Photographed/Recorded

If individual photographed/recorded is under eighteen (18) years old, the following section must be completed: I have read and I understand this document. I understand and agree that it is binding on me, my child (named above), our heirs, assigns and personal representatives.

I acknowledge that I am eighteen (18) years old or more and that I am the parent or guardian of the child named above.

Printed Name of Parent/Guardian:

Signature of Parent/Guardian of Individual Photographed/Recorded

Thanks for registering!