I certify that by submitting this form, I am the parent or legal guardian of the person whose information is being provided to Modified Athletics For Kids, Inc. ("Modified Athletics") (or, if I am the individual signing myself up for Camp WACK, I am at least 18 years old and do not require a guardian).
I acknowledge that Modified Athletics intends for the information I am submitting to be available only to Modified Athletics staff and to be password protected; however, the information will be stored via the internet, and there are limitations to security and privacy of the internet that are beyond our control. Modified Athletics cannot guarantee that all data submissions will be secure or that your information will remain private.
I acknowledge that if my child is no longer a participant in Camp WACK (or if applicable, I am no longer a participant), I can request that Modified Athletics delete from its databases all personally-identifiable information that I’ve submitted, except that information which Modified Athletics is legally obligated to retain.
In exchange for my being allowed to participate in the Modified Athletics for Kids-Camp WACK (“program”), I, and if I am not yet 18 years old, my parent or legal guardian, agree to be bound by each of the following:
- Identification of Risks. I understand that participation may involve risk of injury, disability or death.
- Assumption of Risks. I assume all risks connected with my participation in the Program. I accept personal responsibility for any liability, injury, loss or damage in any way connected with my participation in the Program.
- Assumption of Risks. I assume all risks connected with my participation in the Program. I accept personal responsibility for any liability, injury, loss or damage in any way connected with my participation in the Program.
- Indemnification. I agree to indemnify, defend, and hold harmless, Modified Athletics for Kids and Camp Wack, and all of its affiliated organizations, directors, officers, employees, agents, successors, and assigns from any claims, responsibilities, or liabilities, including attorney’s fees, out of my participation in the Program.
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Consent for Medical Treatment. I agree that Modified Athletics for Kids and Camp WACK may, but have no duty to provide me, through medical personnel of their choice, medical assistance, transportation, and emergency medical services. *OR*
IF THE PERSON PARTICIPATING IN THE PROGRAM IS NOT YET 18 YEARS: As a parent or legal guardian of the above named child, I verify that I fully agree to, understand, and accept all provisions of this Waiver, Release, and Consent.
Waiver/release of liability/consent to medical attention:
THIS IS A LEGAL DOCUMENT AND IS A BINDING CONTRACT AND RELEASE. IF YOU DO NOT UNDERSTAND ANY PORTION OF IT OR DO NOT WISH TO AGREE TO THE TERMS CONTAINED HEREIN, CONSULT AN ATTORNEY AND DO NOT SIGN THIS DOCUMENT. I HAVE READ THIS WAIVER, RELEASE, AND CONSENT AND UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS CONTAINED HEREIN. I AM SIGNING THIS WAIVER, RELEASE, AND CONSENT VOLUNTARILY.