LIABILITY WAIVERPlease complete the following waiver with the participant's information. Participant's Name * First Name Last Name Today's Date MM DD YYYY Participant's Year of High School Graduation Parent/Guardian's Phone (###) ### #### Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Name (if parent/guardian cannot be reached) * Please select the reason for submitting a waiver. Private Lessons Clinic CKM Complete Live Guest Coaching Coaching Clinic Evaluation Facility Rental Does the Participant have any known allergies that would prevent her from participating fully in athletics at CKM or any other allergies that would be pertinent for an emergency professional to know? Does the Participant take any medications that would prevent her from participating fully in athletic events at CKM or any other medication history a doctor would need to know about in an emergency? Does the Participant have any injuries that would prevent her from participating fully in athletic activities at CKM or any other injury that a doctor would need to know about in an emergency? Do you know of any disease/ailment that could impact the Participant's ability to participate in softball? If yes, please explain: I, for myself and on behalf of my heirs, assigns, personal representation and the next of kin, HEREBY RELEASE, IDEMNIFY, AND HOLD HARMLESS CKM Softball Academy, LLC, their officers, officials, agents and/or employees, other participants sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of the premises used to damage person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce the risk, the risk of serious injury does exist; and I willingly agree to comply with the stated and customary terms and conditions for my participation. If, however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and I am aware that there are many people in this facility at any given time and as a result, care must always be used by all participants to avoid danger or injury to other and I knowingly acknowledge that there is a risk of injury that could occur as a result of acts of other participants. * Please Initial Below: * By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by participation; and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at CKM may result from the actions, omissions, or negligence of myself and others, including, but not limited to, CKM’s employees, volunteers, and program participants and their families. Please Initial Below: * I represent that I have adequate insurance to cover any injury or illness I may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury or illness myself. I further represent that I have no medical or physical condition which could interfere with my safety in this activity, or else I am willing to assume – and bear the costs of – all risks that may be created, directly or indirectly, by any such condition. In the event that I file a lawsuit, I agree to do so in the State of Connecticut where CKM is located, and I further agree that the substantive law of that state shall apply. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing. Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release and agree that the opportunity to participate at the stated cost in return for the execution of this release is a reasonable bargain. I have read and understood this document and I agree to be bound by its terms. * Please Initial Below: * I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE: This is to certify that I, as a parent/guardian with legal responsibilities for the participant, do consent and agree to his/her release as provided above all the Releases, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. * AUTHORIZATION SIGNATURE: Please sign your FULL NAME * Thank you! Your waiver has been submitted.
