2023 ATHLETE WAIVER FORM

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WAIVER FORM
Thank You in advance for taking the time to fill out the form!!!
Please pick program that your athlete is signing up for.*

Top of The AM - 9am - 11:30am - Saturdays [ D1 Elite ]Top of The AM - 11:30am - 1:30pm - Saturdays [ U-14 ]1 on 1 Training - Private Training during the Week 6am - 8amOther
What is your goal? *
Please submit film so it can Assets.
Athlete Information
Athlete's Name*

First NameLast Name
Gender*

MaleFemale
Birth Date

MonthDayYear
E-mail*
example@example.com
School
Example: West Hill C I
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Currently in grade.
Currently Age
Shoes Size
Shorts Size
Shirt Size
NOVEL CORONAVIRUS (COVID-19) ACKNOWLEDGEMENT AND ASSUMPTION OF RISK WAIVER
I am currently not experiencing COVID19 symptoms nor have I had COVID-19 symptoms in the last 14 days.

I have not travelled outside of Canada or in an area under a travel health advisory in the last 14 days.

I have not provided care or had close contact with any person with COVID-19 or with any person reasonably suspected of having COVID-19 or with any person who travelled outside of Canada in the last 14 days or with any person who travelled in an area under a travel health advisory in the last 14 days.

I represent and warrant to the Release that I have not been advised by the Government of Canada or Ontario Public Health or my doctor or the Ontario Ministry of Health website to self-isolate due to possible exposure to COVID-19.

I am fully aware of the risks and hazards with respect to COVID-19 inherent in my attendance at the Premises and participation in the activities of training with ACCOUNTABILITY ONE PLAYER SHARPENS ANOTHER CAMPS.

I freely and voluntarily agree to assume the risk with respect to COVID-19, including the risk of death, bodily injury or property damage, regardless of severity, that I (or my child/ward) may sustain as a result of my participation in the activities of ACCOUNTABILITY ONE PLAYER SHARPENS ANOTHER CAMPS. or attendance at the Premises, howsoever arising, including, but not limited to, the active or passive negligence of the Releasees.

I will follow all preventative measures and guidelines given by the Province of Ontario’s Medical Advisors in regards to COVID-19 while participating with ACCOUNTABILITY ONE PLAYER SHARPENS ANOTHER CAMPS.

· Payments are final and non refundable. If there is a cancelation and the booked sessions are not complete the client has the opportunity to rebook at a later date.
Athlete Signature or Parent If Athlete is not an Adult:*

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Date

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Date
PROGRAM POLICIES
· Dane Smith must be notified 24 hours in advance for cancellations. If notification is not at least 24 hours in advance or the session is missed the participant will be charged for the session.

· Clients are to meet the Sports Coach at the agreed upon training venue at the scheduled appointment time, unless an alternate meeting place has been agreed upon between client and the Sports Coach.

· Payments are final and non refundable. If there is a cancelation and the booked sessions are not complete the client has the opportunity to rebook at a later date.
ASSUMPTION OF RISK FOR PARTICIPATION
Each participant in the ACCOUNTABILITY ONE PLAYER SHARPENS ANOTHER CAMPS Program should realize that there are substantial risks, hazards, and danger inherent in such training.

It is the responsibility of each participant to participate only in those activities for which he/she has the prerequisite skills, qualifications, preparation, and training.

Dane Smith does not warrant or guarantee in any respect the physical condition or any equipment used in connection with the activity.

Therefore, in consideration of the benefits received from the ACCOUNTABILITY ONE PLAYER SHARPENS ANOTHER CAMPS, the undersigned assumes all risks of damages or
injury, including death that may be sustained by him/her while participating in an exercise activity or in travel to or from such activity.
Signature*

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Date

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Date
RELEASE, COVENANT NOT TO SUE AND WAIVER
The ACCOUNTABILITY ONE PLAYER SHARPENS ANOTHER CAMPS training involves an inherent risk of physical injury and the undersigned assumes all such risks.

The undersigned hereby agrees that for the sole consideration of Dane Smith allowing the undersigned to participate in the ACCOUNTABILITY ONE PLAYER SHARPENS ANOTHER CAMPS for which or in connection with which Dane Smith has made available any equipment, facilities, grounds, or personnel for such training, the undersigned does hereby release, covenant not to sue, and forever discharge Dane Smith and his officers, agents, and employees of any and for all claims, demands, rights, and causes of action of whatever kind or nature including but not limited to negligence, unforeseen bodily and personal injuries, damage to property, and the consequences thereof resulting from participation in any way connected with such recreational programs and activities.

The undersigned understands that this Release, Covenant Not to Sue, Waiver, and Assumption of Risk shall be effective from the date of signature until the effective termination of the ACCOUNTABILITY ONE PLAYER SHARPENS ANOTHER CAMPS by Dane Smith.

By signing this document, the undersigned hereby acknowledges that he/she has read the above carefully before signing, and agrees to comply with all the above.
I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent and legally authorized to execute this agreement on behalf of above team.ORI am the parent and/or legal guardian of the child and understand the foregoing statement, and am competent to execute this agreement.
Date

MonthDayYear
Date
RELEASE FORM FOR MEDIA RECORDING:
I, the undersigned, do hereby consent and agree that ACCOUNTABILITY ONE PLAYER SHARPENS ANOTHER CAMPS, its employees, or agents have the right to take photographs, videotape, or digital recordings of me while training with Running for Your Life and to use these in any and all media, now or hereafter known, and exclusively for the purpose of a video and/or picture displaying activities, training, coaching, mentoring and testimonials. I further consent that my name and identity may be revealed therein or by descriptive text or commentary.

I do hereby release to ACCOUNTABILITY ONE PLAYER SHARPENS ANOTHER CAMPS, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used.

I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback.

I also understand that ACCOUNTABILITY ONE PLAYER SHARPENS ANOTHER CAMPS is not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as a result.
I represent that I am at least 18 years of age, have read and understand the foregoing statement of Media Release, and am competent to execute this agreement.ORI am the parent and/or legal guardian of the child being filmed and understand the foregoing statement Media Release, and am competent to execute this agreement.
Date

MonthDayYear
Date
CLIENT HEALTH QUESTIONNAIRE
All information received on this form will be treated as strictly confidential. Please fill out completely and accurately. This information is essential to helping us develop a program that addresses your child’s goals and interests and is safe and effective.

MEDICAL CONDITIONS

Please indicate any significant medical conditions, physical limitations, or any other concerns that might affect your child’s/ward’s full participation in ACCOUNTABILITY ONE PLAYER SHARPENS ANOTHER CAMPS.
Asthma.Chronic NosebleedDiabetesDigestive upsetsEar, Nose, Throat infectionsDislocated shoulder; swollen, painful joints; ‘trick or lock’ knee or other joint disabilityFainting SpellsFeet or Leg problemsHemophilia/Bleeding disordersillness or operationRheumatic FeverSeizuresSleepwalkingUrinary infectionsN/A**Other
Give details of usual treatment for each of the above conditions indicated:
Example: Peanuts,Dairy etc
Please explain if your child/ward has any medical condition that requires any modification of his/ her program.
Example: Peanuts,Dairy etc
GENERAL
Yes____ No____ (1) Does your child/ward wear or carry medical alert identification (e.g., bracelet)?If yes, please specify what is written on it:
Example: Peanuts,Dairy etc
Yes____ No____ (2) Does your child/ward have any other relevant medical condition that will require modification of the program?If yes, please explain:
Example: Peanuts,Dairy etc
(A) Foods: (If foods are life-threatening, please explain the symptoms and the treatment)
Example: Peanuts,Dairy etc
(B) Medications
Example: Peanuts,Dairy etc
(c) Other (e.g., bee or wasp stings, environmental allergies)
Example: Peanuts,Dairy etc
Yes____ No____ Has your child/ward suffered any serious allergic or asthmatic reaction?If yes, please provide details, including the type and severity of reaction:
Example: Peanuts,Dairy etc
ALLERGY CONSIDERED:
Has a doctor prescribed an Epi-Pen for your child/ward?

YesNo**Other
Has a doctor prescribed an inhaler for asthma? (Prescribed asthma inhalers must be carried by the child during training.)

YesNo**Other
Has a doctor prescribed an inhaler for any other reason?

YesNo**Other
MildModerateSeriousLife - ThreateningYesNo**Other
DIETARY RESTRICTIONS
Please list any foods your child/ward should not eat for medical, dietary, or religious reasons:
Example: Peanuts,Dairy etc
MEDICATION
Does your child/ward take prescribed medication on a regular basis? Please specify:
Example: Peanuts,Dairy etc
What prescribed medication(s) should your child/ward have with him/her during training?
Example: Peanuts,Dairy etc
Should it become necessary for my child/ward to have medical care, I hereby give the coach permission to use her/his best judgment in obtaining the best of such service for my child/ ward. I also understand that in the event of such illness or accident, I will be notified as soon as possible.
Signature*

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Date

MonthDayYear
Date
Athlete Name

First NameLast Name
Birth Date

MonthDayYear
Physician’s Name Parent/Guardian Signature

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Date

MonthDayYear
Date
Parent/Guardian Information
Name*

First NameLast Name
Email*
example@example.com
Home Number
Cell Number*
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship
Phone Number*
Alt. Phone Number
Email
example@example.com
Signature*

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Informed Consent and Acknowledgement

I hereby give my approval for my child / athlete participation in any and all activities prepared by Dane Smith during the selected training session. In exchange for the acceptance of said child / athlete candidacy by Accountably One Player Sharpens Another Basketball Training., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Accountably One Player Sharpens Another Basketball Training. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Accountably One Player Sharpens Another Basketball Training. including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Release of liability and assumption of risk.

In consideration of my participation in this A.O.P.S.A. Association program, i hereby waive, release and discharge any and all claims for damages i may have , or which may hereafter accrue to me as a result of my participation in this activity. This release is intended to discharge in advance the instructors, promoters, sponsors, organizers, project manager, of this activity and any involved public school entity (and their respective agents and employees) including but limited to the A.O.P.S.A. Association program and partnered cabbegetown youth centre and their employees, agents and directors, from and against any and all liability, which may arise out negligence or carelessness on the parts of the person or entities mentioned above.
Athlete Signature or Parent If Athlete is not an Adult:*

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Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature*

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Date

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Date
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Thank You in advance for taking the time to fill out the form!!!