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2017 Stampede Track and Field Registration/Waiver Form
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Athlete's First Name:
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Athlete's Last Name:
Athlete's Phone::
Athlete's Email::
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Athlete's Date Of Birth::
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Parent's First Name:
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Parent's Last Name:
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Parent's Phone #::
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Parent Email::
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Address (Street)::
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City::
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State::
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Zip::
Uniform Size:
Youth XS
Youth Small
Youth Medium
Youth XL
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Adult XXXL
Preference:
Sprints (100m, 200m, or 400m)
Hurdles (12u and up)
Middle Distance (800m)
Distance (1600m, 3200m, Steeplechase)
Jumps (Long Jump or Triple Jump)
Throws (Shot Put, Javelin, or Discus)
Off-Season Conditioning for other sports
AMATEUR ATHLETIC MINOR WAIVER AND RELEASE OF LIABILITY
In order to be allowed to participate in Stampede Track and Field for the 2017 Summer Track and Field Season, for all related events and activities, the undersigned:
1. Agrees that the parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating he or she should inspect the facilities and equipment to be used and if the participant believes anything is unsafe, he or she should immediately advise his or her coach or supervisor of such condition and refuse to participate.
2. ACKNOWLEDGES AND FULL Y 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 not only from their own actions, inactions or negligence, but the actions, inactions or negligence of others, the rules of play, or the condition of premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.
3. ASSUMES ALL THE FOREGOING RISK AND ACCEPT PERSONAL RESPONSIBILITY FOR ANY
DAMAGES, INJURY, PERMANENT DISABILITY, OR DEATH.
4. RELEASES, WAlVES, DISCHARGES AND COVENANTS NOT TO SUE THE STAMPEDE TRACK AND FIELD PROGRAM, MYAA, INC. or any affiliated clubs, their respective administrators, directors, agents, coaches, representatives, sponsors, and other employees of the organization. Other participants, sponsoring agencies, advertisers, and if applicable, owners and leasers of premises used to conduct the events, all of which are hereinafter referred to as "releases", from any and all liability of each of the undersigned his or her heirs and next of kin for any and ALL CLAIMS, DEMANDS, LOSSES OR DAMAGES ON ACCOUNT OF INJURY, 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.
I (WE) HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY.
Signature:
Date:
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