Wisconsin Ice Next Gen Shavings Clinic

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When: Saturday, May 4th

*9-10:30am (Ages 5-8/K-2nd Grade)

*10:30-Noon (Ages 9-12/3rd-6th Grade)

Where: Stevens Point Recreation Center

2442 Sims Ave, Stevens Point 54481

$20 per session

Please join us for our 14 National's fundraiser for the trip to AAU National Championships in Orlando, FL this June. Sessions will be led by Shelly & Jay Johnson and the players of Wisconsin Ice 14 National.

Payment methods accepted: Venmo @Janelle-Smith-59 , Cash, Check
Contact: Jay & Shelly Johnson at (715) 340-0466 or sjjohnson@charter.net

READ BEFORE SIGNING IN CONSIDERATION OF my child/ward being allowed to participate in any way in the Wisconsin Ice related events and activities, the undersigned acknowledges, appreciates, and agrees that: The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) to my child from the activities involved in these programs are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and,
1. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child’s participation; and,
2. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and,
3. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Jay & Shelly Johnson, Wisconsin Ice and Stevens Point Recreation Center; its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
4. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.
5. I, the parent/guardian, assert that I have explained to my child/ward: the risks of the activity, his/her responsibilities for adhering to the rules and regulations, and that my child/ward understands this agreement.

Email *

Participants Name *

Name of Parent/Guardian *

I, FOR MYSELF, MY SPOUSE, AND CHILD/WARD, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, 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 and understand and agree on behalf of myself and my minor child/ward to be bound by the terms of this agreement.”

All members agree to be filmed, videotaped and photographed, and have your name, image, picture, and likeness otherwise recorded, in any media, during participation. You also hereby grant Breit Nelson, with no financial or other compensation due to you, full right and license to use, and to authorize third parties to use, in all media, the Footage for: (1) news and information purposes, (2) promotion of the event(s) in which you participate, (3) promotion of the Sport, (4) promotion of Advanced Performance Volleyball Action/Wisconsin Ice, provided that, in no event may Wisconsin Ice use or authorize the commercial use of the Footage in any manner that would imply your endorsement of any company, product, or service, without your written permission, and (5) promotion of Advanced Performance Volleyball Action/Wisconsin Ice VBC through brochures, it’s website, etc.

Required

UNDERSTANDING OR RISK. I understand the seriousness of the risks involved in participating in this program, my personal responsibilities for adhering to rules and regulation, and accept them as a participant. *

I Agree

Required

Date Signed *

YYYY

Cell Phone *

Address, City, State, Zip *

School *

Grade *

Age *

Emergency Contact Name *

Emergency Contact Phone Number *

Select the individual sessions OR session package you would like to sign up for: *

9-10:30am (Ages 5-8/K-2nd Grade)

10:30-Noon (Ages 9-12/3rd-6th Grade)

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A copy of your responses will be emailed to the address you provided.

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