Registration and Waiver of Liability Minor

Registration and waiver of liability - minor

Child's Name *

First

Last

Child's Gender

Child's Date of Birth *

Parent or Guardian's Name *

First

Last

Parent or Guardian's Date of Birth *

Email *

Confirm Email

Phone Number *

Type of Membership *

PeeWee (grades 2-4) - $40/month
Youth (grades 5-12)- $75/month
Competitive Boxing - $75/month (requires coach's approval)

Method of Payment *

I will pay cash at the gym
I will pay with a credit/debit card at the gym
Please send me a link to pay online

Boxing Experience *

Emergency Contact Name & Relationship to Member *

Emergency Contact Phone *

ATHLETIC ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY. IN CONSIDERATION OF my child/ward named above being allowed to participate in any way in the Al Amanecer Boxing Club related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1) 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, 2) 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 RELEASEES or others, and assume full responsibility for my child’s participation; and, 3) 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, 4) 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 Al Amanecer Boxing Club; 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. 5) 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. 6) I, the parent/guardian, assert that I have explained to my child/ward: the risks of the activity, his/her responsibilities for adhering to Al Amanecer Boxing Club’s rules and regulations, and that my child/ward understands this agreement. *

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.

As the parent/legal guardian of a participant in Al Amanecer Boxing Club, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry, if I am unavailable to be contacted to provide necessary consent at the time of incident. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of the participant. *

I consent to Emergency Medical Treatment.
I do not consent to Emergency Medical Treatment.

I hereby authorize Al Amanecer Boxing Club to publish photographs taken of my minor child/ward, and my minor child’s/ward’s name, and likeness, for use in Al Amanecer Boxing Club’s print, online and video-based marketing materials, as well as other publications. I hereby release and hold harmless Al Amanecer Boxing Club from any reasonable expectation of privacy or confidentiality for myself and/or any minor child and/or children listed above associated with the images specified above. I further acknowledge that participation is voluntary and that neither I and/or the minor child or children will receive financial compensation of any type associated with the taking or publication of these photographs or participation in Al Amanecer Boxing Club’s marketing materials or other publications. I acknowledge and agree that publication of said photos confers no rights of ownership or royalties whatsoever. I hereby release Al Amanecer Boxing Club, its contractors, its employees, and any third parties involved in the creation or publication of marketing materials, from liability for any claims by me or any third party in connection with my participation and/or the minor children listed above. *

I consent to the Photo Release.
I DO NOT CONSENT to the Photo Release.

I understand that I have 5 (Five) days from the date of entering this membership contract in which to cancel. Al Amanecer Boxing Club agrees to refund any fees paid if canceled within the aforementioned 5 days, less fair compensation for any services provided (up to a maximum of $100). *

I HAVE READ AND UNDERSTOOD THE ABOVE AGREEMENT.

Parent/Guardian's Name *

Today's Date *