Mini Athletes | Sports Programs for Kids Ages 2 to 6! | Norwood MA | waiver
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Mini Athletes Waiver Form

Participant's Name
Age
Date of Birth
If attending a Birthday Party Name of Birthday Boy/Girl:
Participant's Legal Guardian
Street Address
city
state
zipcode
home phone
cell number
Are there any physical conditions or limitations that our Mini Athletes coaches and staff should be aware of that may affect or limit your child’s participation?
*If yes, please explain
I do hereby give permission for my child to participate in the Mini Athletes programs at the Athletic Republic, Norwood. I understand that he (she) is using Mini Athletes at his or her own risk. I specifically agree to waive and release Mini Athletes and Athletic Republic and its employees, agents and officers from any and all claims for loss of damage of property, liability, or personal injury that may arise from the use of Mini Athletes. I have read, understand, and agree to all of the foregoing. I hereby give permission for images of my child and the use of photographs and/or video singularly or in conjunction with other photographs to be used by Mini Athletes, for advertising, publicity, commercial or other business purposes and waive any rights of compensation or ownership thereto. I understand that the term "photograph" as used herein encompasses both still photographs and video footage. I hereby release Mini Athletes, and any of its associated or affiliated companies, their directors, officers, agents and employees from all claims of every kind of account of such use.
I certify that I am the parent/legal guardian of the individual named above, I have read this release and approve of its terms.
*Please note that any allergy information should be communicated directly to the host family.
Date
Electronic Signature**