Child's Name *
Child's Name
Parent Name
Parent Name

Promotional Material:
I authorize the Academy and affiliates to use my child’s (or my) photograph or video for promotional and/or commercial purposes, including,
but not limited to, brochures, newsletters, promotional materials, websites, and television media. I release the Academy and affiliates, from
any liability from such use.
Code of Conduct and Termination Rights:
In the event that a player refuses to follow directions or exhibits aggressive or unsafe behavior, we will notify the parent(s) / guardian(s) and
request that the player be picked up immediately. Refunds are not available if the player is picked up early due to such behavior. The
Academy reserves the right to request the withdrawal of any athlete at any time, if the athlete has violated the policies and procedures of the
Academy, or if the withdrawal of the athlete is in the best interest of the Academy’s program and its other participants.
General Waiver of Liability:
With regard to my child and myself:
1. I hereby assume all risks and responsibilities of possible damage or injury involved through participation in the academy. I understand that
I am to furnish my own insurance.
2. I agree to indemnify and hold harmless the Academy, its employees, officers and agents from all actions, claims and demands by reason
of any loss or injury which may be sustained by me during all training, tournaments, events and related activities. I hereby assume all risk of
any such loss or injury. I have read and understand the above policies and information.
Medical Waiver:
In the event of any, illness or other medical circumstance incurred while my child (or myself) is attending the Academy, Camp or any other
activity (either on or off the premises of), I hereby give permission to any responsible person employed by the Academy, to take my child (or
myself) to an appropriate treatment facility for any necessary treatment. I agree to hold the above people of authority harmless from any
action in this respect. I hereby authorize The Academy to release my child’s (or my) medical form to appropriate personal. I hereby release,
hold harmless, and forever discharge The Academy, its employees, officers and agents from all actions, claims and demands by reason of
any loss or injury which may be sustained by me or my child during all training, tournaments, events and related activities. I hereby assume
all risk of any such loss or injury.


Sign Authorization___________________________________________