Joe Licata Football Waiver Form
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Email *
Child's First Name *
Child's Last Name *
Parent/Guardian Name *
Parent/Guardian Email *
Parent/Guardian phone Number *
School *
Grade in Fall '22 *
Medical Conditions
My child is subject to the following allergies or medical conditions, and I authorize the Organization to disclose such allergies or medical conditions to a physician in the event that my child should require emergency medical care (describe allergies or medical conditions in reasonable detail).  If left blank, I certify that my child suffers from no allergies or medical conditions to my knowledge of which a physician should be notified in the event that my child should require emergency medical care:
Prohibited Activities
As a result of the medical conditions described above or for other reasons, I do not want my child to engage in any of the following activities (describe in reasonable detail). If left blank I certify that there are no limitations on my child’s participation:
AUTHORIZATION AND WAIVER
            Each of the undersigned parent(s) or legal guardian(s) of a participant states as follows:

            I am aware that normal and usual athletic and sports related activities have certain inherent risks and may cause injury.  I understand that there are certain risks and hazards involved in participating in sports, and with quarterback training in particular, including, but not limited to hazards associated with running, jumping, throwing, catching, sliding, diving, stretching and collisions with other participants, coaches, bystanders, or stationary objects, all of which can cause serious injury or death.  However, I want my child to participate in Football training. (the “Activities”) sponsored by Joe Licata Football, Inc., a New York corporation (the Organization”), and I give my unqualified permission and consent for my child to participate in the Activities.

            My child has the necessary skills and is able to participate in all reasonably anticipated aspects of the Activities. The nature of the Activities has already been fully disclosed to me.

            On behalf of my child, I hereby indemnify, release, hold harmless and forever discharge the Organization and its agents, employees, officers, directors, affiliates, successors and assigns, of and from any and all claims, demands, debts, contracts, expenses, causes of action, lawsuits, damages or liabilities, of any kind or nature, whether known or unknown, in law or in equity, that I ever had or may have, arising from or in any way related to my child's participation in any Activities conducted by, on the premises of, or for the benefit of the Organization; provided, that this Authorization and Waiver does not apply to any acts of gross negligence, or intentional, willful or wanton misconduct.

            I grant to the Organization, its agents, employees, representatives, successors and assigns the right to take photographs and videos of my child in connection with football training. I authorize the Organization, its agents, employees, representatives, successors and assigns to copyright, use and publish same in print and/or electronically.  I agree that the Organization may use such photographs and videos with or without my child’s name and for any lawful purpose and I understand that I will not be entitled to be compensated for such authorized use.

            This Authorization and Waiver is binding upon me, my heirs, executors, legal representatives, successors and assigns. The provisions of this Authorization and Waiver will continue in full force and effect even after the termination of the activities conducted by, on the premises of, or for the benefit of the Organization, whether by agreement, by operation of law, or otherwise.

            This Authorization and Waiver is governed by the laws of the State of New York and is intended to be as broad and inclusive as is permitted by that law. If any provision of this Authorization and Waiver is held invalid or unenforceable by a court of competent jurisdiction, the remaining provisions will continue to be fully effective.

             This Authorization and Waiver contains the entire agreement between the parties, and supersedes any prior written or oral agreements between them concerning the subject matter of this Authorization and Waiver. The provisions of this Authorization and Waiver may be waived, altered, amended or repealed, in whole or in part, only upon the prior written consent of all parties.

            In the event that I cannot be reached, I authorize and direct any adult Activities sponsor representing the Organization to make emergency medical decisions for my child.
I am of lawful age and legally authorized and competent to sign this document; I understand the terms herein; and I have signed this document of my own free will. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.  By typing my name below, I am electronically signing my application *
PARTICIPANT'S RESPONSIBILITIES AND CODE OF CONDUCT
             As a Participant in Football Training sponsored by Joe Licata Football, Inc., I understand that I have certain responsibilities to myself, other participants, and instructors and staff of Joe Licata Football, Inc. I agree to the following:

            1.         I am physically able to participate in Football Training. I understand that I will be required to run, jump, throw, catch, stretch and other related physical activities.

            2.         I understand that there are risks and hazards involved in Football Training, including but not limited to falls and collisions.  If I do not feel well or if I have been injured, I will immediately advise my instructor.

            3.         I will treat all instructors, staff, guests and fellow participants with respect and shall follow directions from instructors and staff to the best of my ability.

            4.         I will avoid any verbal arguments or physical altercations with instructors, staff, guests and fellow participants.

            5.         I will not consume any alcohol or un-prescribed drugs prior to or during my participation in Football Training.

            6.         I understand that if I violate any of the terms of these Participant’s Responsibilities and Code of Conduct, I forfeit my right to participate in Football Training and may be required to leave the program.
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.  By typing my name below, I am electronically signing my application *
PARENT/GUARDIAN ACKNOWLEDGEMENT OF PARTICIPANTS RESPONSBILITIES AND CODE OF CONDUCT
I have read the above Participant’s Responsibilities and Code of Conduct and agree to its terms and authorize my child to sign.  I further understand that a breach of the above Participant’s Responsibilities and Code of Conduct by my child may result in the dismissal of my child from Quarterback Training in the sole discretion of the Instructor and that in that event, I will forfeit any prepaid tuition. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.  By typing my name below, I am electronically signing my application. *
OTHER COMMENTS/CONCERNS
A copy of your responses will be emailed to the address you provided.
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