BCC SB Clinic Wavier Form (Run by That Power Game)
In order for your daughter to participate, you must fill out this form prior to the start of camp. A copy of the form will be sent to you after you complete the form.
That Power Game LLC run the BCC camps and clinics. 
Email *
ACTIVITY WAIVER AND RELEASE
In exchange for participating in the Activity, I, the below-signed Participant, hereby agree as
follows:
1. ACTIVITY DEFINED. I am signing this Activity Waiver and Release (the "
Agreement") in regards to the following event or activity (the "Activity"): Sports Camp.
The Activity includes all activities or events provided, organized, or sponsored by the
Activity Provider in any way related to the Activity, including, but not limited to, any travel,
transport, or accommodations to or from the Activity location(s) provided by the Activity
Provider.
a. Location(s): Town Creek Vision 215 Sunnybrook Way SE, Leland, NC 28451
b. Date(s): July 2022 through June 2023
2. WAIVER AND RELEASE. I HEREBY ASSUME ALL RISKS OF MY
PARTICIPATION IN THE ACTIVITY and waive all claims and forever release That Power
Game LLC, located at _____________, _____________, _____________ _____________,
including its officers, employees, successors, assigns, partners, agents, heirs, representatives,
and volunteers ("Activity Provider"), as applicable, in their individual or corporate
capacities, of all claims, liabilities, agreements, and causes of action of any nature due to any
injury, loss, or damage to person or property, including but not limited to serious or
permanent physical injury, psychological injury, illness, death, and economic or emotional
damages, that may arise out of my participation in the Activity, notwithstanding that such
injury, loss, or damage may be due to Activity Provider's negligence.
3. INDEMNIFICATION. I agree to indemnify, defend, and hold harmless Activity Provider
against all claims, liabilities, damages, judgments, expenses, and causes of action of any
nature, including attorney's fees and related costs, arising out of or related to my
participation in the Activity, whether or not such causes of action may be due to Activity
Provider's negligence.
4. PHYSICAL AND MENTAL FITNESS. I do not have any physical or mental limitations
or disabilities that may limit or prevent me from safely participating in the Activity. I agree
that I will not participate in the Activity under the influence of any drugs that could impair
my physical or mental abilities. Activity Provider may require that I obtain an evaluation and
clearance from a certified physician or healthcare provider certifying my ability to
participate.
5. GENERAL TERMS. This Agreement will be binding on and inure to the benefit of the
parties and their respective heirs, representatives, executors, successors, and assigns. The
terms of this Agreement are severable. This means that if any term of this Agreement is held
to be invalid or unenforceable, then the remaining terms will continue to remain valid and
enforceable. This Agreement represents the entire agreement between the parties and
supersedes any and all prior oral or written agreements. This Agreement may not be
modified except by the written consent of both parties. This Agreement will be governed and
construed according to North Carolina law and will be broadly construed to release Activity
Provider from liability to the maximum extent permitted by the applicable law.
6. ACKNOWLEDGEMENTS
a. I understand that I may not participate in the Activity unless I sign this Agreement.
b. I AGREE THAT I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY
OWN RISK. I UNDERSTAND THAT THE ACTIVITY INVOLVES CERTAIN
INHERENT RISKS, INCLUDING THE RISK OF PHYSICAL INJURY AND
PROPERTY DAMAGE, AND THAT BY SIGNING THIS AGREEMENT I AM
ASSUMING FULL RESPONSIBILITY FOR THESE RISKS AND FOREVER GIVE
UP MY LEGAL RIGHT TO SUE OR OTHERWISE CLAIM AGAINST ACTIVITY
PROVIDER FOR ANY INJURY, PROPERTY DAMAGE, OR OTHER LOSS THAT I
MAY SUSTAIN DUE TO MY PARTICIPATION IN THE ACTIVITY WHETHER OR
NOT DUE TO ACTIVITY PROVIDER'S NEGLIGENCE.
c. I agree to comply with all written and oral rules and instructions provided by Activity
Provider regarding my participation in the Activity. I have been advised and instructed
on the use of any protective equipment needed for the Activity.
d. I agree that Activity Provider may make photo, audio, video, and other media recordings
of my participation in the Activity, and Activity Provider will be the sole owner of all
such media, which may be used for all lawful marketing or business purposes.
e. I agree to pay all costs of any medical care or treatment that I may require as a result of
my participation in the Activity. I understand that I am responsible for obtaining my own
health insurance. I further agree to pay for any damages I cause to person or property
due to my participation in the Activity as a result of my intentional, negligent, or
reckless act or omission.
f. I am signing this Agreement voluntarily and free of duress with the intention of binding
my spouse, heirs, executors, legal representatives, and assigns, if any.
g. I have fully read and understood this Agreement, and I have been encouraged and had an
opportunity to seek independent legal advice concerning this Agreement prior to signing.
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