Power Haus Event Registration and Waiver

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8719 Hanover Industrial Dr. Columbia, IL 62236
618-939-7827
info@powerhauscheer.com

Mother's Name *

Mother's Email *

Mother's Phone Number *

Father's Name *

Father Email *

Father Phone *

Address *

Athletes Names (please list all) *

Athletes Birthdays (please list all) *

WAIVER AND RELEASE OF LIABILITY: In consideration of being allowed to participate in any way in any of the Power Haus Cheer or Metro East Power Haus athletic/sports programs and related activities/birthday parties the undersigned: 1. Agrees that prior to participating, they will inspect the facilities and equipment to be used and if they believe anything is unsafe, they will immediately advise their coach or supervisor of such conditions and refuse to participate. 2. Acknowledges and fully understands that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death and severe social and economic losses which might result from their own actions, inaction or negligence of others, the rules of play or the condition of the premises or of any equipment used. Further, that there may be other risks not known to Power Haus Cheer and Dance of Columbia Inc. or Metro East Power Haus Inc. or reasonable foreseeable at this time. 3. Assumes all the foregoing risks and accepts personal responsibility for damages which may hereinafter occur following such injury, permanent disability or death. 4. Releases, waives, discharges and covenants not to sue Power Haus Cheer and Dance of Columbia Inc. or Metro East Power Haus Inc. or Ziklag LLC, their respective administrators, directors, agents, coaches and other employees of the organizations, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leaser of the premises used to conduct an event, all of which are hereafter referred to as "RELEASEES" from demands, losses or damages on account of injury from future participation, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the "RELEASEES" or otherwise. Power Haus Cheer and Dance of Columbia Inc., Metro East Power Haus Inc., Ziklag LLC which are individual Illinois Corporations. 5. Agrees to carry personal health insurance in case of a sports injury. 6. RELEASES THE RELEASEES AND EXPRESSLY ASSUMES THE RISK OF INJURY AND DAMAGES; and will indemnify and hold harmless the "RELEASEES" as to any claims for injury and damage. You grant Power Haus Cheer and Dance of Columbia Inc. and Metro East Power Haus Inc. and Ziklag LLC the right to utilize your image (or your child's image) on any reproduction for marketing purposes, including but not limited to brochures, banners, website, social media, print, video and billboards. --I the undersigned have read the above waiver and release and understand they they have given up substantial rights by signing and do so voluntarily. (please initial you understand) *

MINOR RELEASE: AND I, THE MINOR'S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF ATHLETIC/SPORTS PROGRAMS AND RELATED ACTIVITIES, AND THE MINOR'S EXPERIENCE AND CAPABILITES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ALL LIABILITY CLAIMS, DEMANDS, LOSSES OR DAMAGES ON THE MINOR'S ACCOUNT CAUSES OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATION AND FURTHER AGREE THAT IF, DESPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR'S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASEES NAMED ABOVE, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM. --I the undersigned have read the above waiver and release and understand they they have given up substantial rights by signing and do so voluntarily. (please initial you understand) *

I understand that If my athlete is taking virtual lessons, they are acting of their own free will. I understand that the coach will only ask them to do skills they are physically capable of and will offer them modifications as needed. Knowing their coach takes their safety into account, I take full responsibility if my athlete injures themselves. (please initial you understand) *

Parent Name Printed *

Date *

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Parent Signature (By signing this I agree that this signature is valid ) *

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