Big Impact Kicking Registration Form

Athlete Information

Athlete's Name

First NameLast Name

Age

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Home Number

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

WAIVER, INDEMNITY, AND RELEASE OF LIABILITY FORM

In consideration of Big Impact Kicking, LLC permitting Participant (defined below) to participate in this Big Impact Kicking Camp (this “Camp”), I, on behalf of myself, my executors, administrators, heirs, beneficiaries, subrogors, next of kin, insurers, successors, assigns, and anyone who obtains rights from me, hereby agree as follows:

(A) I am 18 years of age or older or, if Participant is a minor, I am the duly authorized parent or legal guardian of Participant and have full authority to execute this Accident Waiver, Indemnity, and Release of Liability (this “Release”) on behalf of Participant.

(B) I hereby assume any and all risks and hazards of participating in this Camp including, without limitation, any and all risks or hazards that may arise from (i) my and other participants participation in the Camp, (ii) the negligent acts or omission on the part of the Released Parties (defined hereinafter) or any third party, or (iii) from any dangerous or defective equipment, materials, goods, or property. I acknowledge that participation in this Camp may carry with it the potential for death, serious injury, and personal loss. The risks may include, but are not limited to, those involving physical activity, terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, and lack of hydration.

(C) I hereby represent and warrant that I am physically fit and have not been advised by a qualified medical professional not participate in this Camp. In addition, I hereby represent and warrant that there are no health-related reasons or problems which preclude my participation in this Camp. I acknowledge that this Release will govern my actions and responsibilities at this Camp.

(D) I hereby fully, forever, and absolutely waive, release, discharge, and covenant not to use the Released Parties from any and all liabilities, claims damages, losses, suits, causes of action, judgments, fines, penalties, investigations, expenses, and costs (including, but not limited to, attorneys’ fees and costs) (collectively, “Claims”) arising out of or related to (i) my participation in the camp and any related activities, (ii) any act, omission, or negligence of the Released Parties (including, but not limited to, negligent rescue operations) or third party including other participants in the Camp, (iii) death, disability, injury, illness, property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and from this Camp. “Released Parties” means Big Impact Kicking, LLC, Rhead Kinder, Brandon Brookfield, and/or their coaches, members, managers, officers, directors, employees, insurers, agents, representatives, volunteers, and their successors and assigns.

(E) I hereby agree to indemnify, defend, and hold harmless the Released Parties from any and all Claims arising out of or related to my participation in this Camp.

I hereby consent and agree that the Released Parties may take photographs, video, or other digital recordings of me as a participant during this Camp and I hereby grant the Released Parties a world-wide, perpetual, irrevocable, paid up, royalty free, sublicensable, and transferable license to use my likeness, name biographical information, and personal attributes, and to modify and present the same in any manner and in any medium (including, without limitation, broadcast, telecast, video, online, or photograph), for any purpose whatsoever without any further notice or compensation.

This Release shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I ACKNOWELDGE THAT I HAVE READ THIS RELEASE, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT VOLUNTARILY AND OF MY OWN FREE WILL. No statements regarding the effect of this Release that are not contained in this Release shall modify the terms of this Release. In any proceeding or other attempt to enforce, construe, or to determine the validity of this Release, I agree to pay the reasonable expenses of the Released Parties including, without limitation, reasonable attorneys’ fees and costs. This Release shall be governed by and construed in accordance with the laws of the State of Colorado without regards to its choice of law principles. Exclusive jurisdiction and venue for any dispute concerning this Release shall be in the federal or state courts located in the City & County of Denver, Colorado. This Release may executed electronically and such signature shall constitute an original signature for all purposes.

Covid-19 Waiver, Indemnity, and Release of Liability

In consideration of Big Impact Kicking, LLC permitting Participant (defined below) to participate in this Big Impact Kicking Camp (this “Camp”), I, on behalf of myself, my executors, administrators, heirs, beneficiaries, subrogors, next of kin, insurers, successors, assigns, and anyone who obtains rights from me, hereby agree as follows:

(A) I am 18 years of age or older or, if Participant is a minor, I am the duly authorized parent or legal guardian of Participant and have full authority to execute this Waiver, Indemnity, and Release of Liability (this “Release”) on behalf of Participant.

(B) I hereby acknowledge that the novel coronavirus (“COVID-19”) has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Big Impact Kicking, LLC has put in place preventative measures to reduce the spread of COVID-19, but cannot guarantee that I will not become exposed to or infected with COVID-19. I acknowledge and agree that attending this Camp may increase my risk of contracting COVID-19.

(C) I hereby acknowledge the contagious nature of COVID-19 and assume any and all risks or hazards that I may be exposed to or infected by COVID-19 while attending this Camp and that such exposure or infection may result in injury, illness, permanent disability, or death. I understand that the risk of becoming exposed to or infected by COVID-19 while attending Camp may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Big Impact Kicking, LLC and its members, managers, officers, directors, employees, volunteers, agents, successors, or assigns (collectively, the “Released Parties”) and program participants and their families.

(D) I hereby assume any and all risks and accept sole responsibility for any injury (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, cost, or expense, of any kind, that I may experience or incur due to COVID-19 in connection with my attendance at this Camp.

(E) I hereby fully, forever, and absolutely waive, release, discharge, and covenant not to sue the Released Parties from any and all liabilities, claims damages, losses, suits, causes of action, judgments, fines, penalties, investigations, expenses, and costs (including, but not limited to, attorneys’ fees and costs) (collectively, “Claims”) arising out of or related to COVID-19 or my participation in this Camp.

(F) I hereby agree to indemnify, defend, and hold harmless the Released Parties from any and all Claims arising out of or related to COVID-19 or my participation in this Camp.

This Release shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. I ACKNOWELDGE THAT I HAVE READ THIS RELEASE, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT VOLUNTARILY AND OF MY OWN FREE WILL. No statements regarding the effect of this Release that are not contained in this Release shall modify the terms of this Release. In any proceeding or other attempt to enforce, construe, or to determine the validity of this Release, I agree to pay the reasonable expenses of the Released Parties including, without limitation, reasonable attorneys’ fees and costs. This Release shall be governed by and construed in accordance with the laws of the State of Colorado without regards to its choice of law principles. Exclusive jurisdiction and venue for any dispute concerning this Release shall be in the federal or state courts located in the City & County of Denver, Colorado. This Release may executed

Parent/Guardian Full Name Date

Athlete/participant Full Name Date

Parent/Guardian Signature

Athlete/Participant Signature

Confirmation

BY SUBMITTING THIS FORM, 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.