AIO Sports Registration

AIO Sports Registration

Register for School Year Athletic Programs and Summer Camp.
Student/Participant Name*

First NameLast Name
Gender*

MaleFemale
Date of Birth*

MonthDayYear
Date
School Attending*
T-Shirt Size*

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult X-Large
Course Selection*

Sports (PreK - 2nd Grade, Tuesday, 3:00 - 4:00pm, during school year)Sports (3rd - 8th Grade, Wednesday, 3:00 - 4:00pm during school year)Mixed Martial Arts/Self Defense (PreK - 8th Grade, Thursday, 3:00 - 4:00 during school year)Mixed Martial Arts/Self Defense (High School - Adults, Wednesday, 6:00 - 7:00 during school year)Mixed Martial Arts/Self Defense (High School - Adults, Wednesday, 4:00 - 5:00 during school year @ Norview Elementary in Norfolk)
Parent/Guardian Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Participation: I/We are willing to volunteer for the following*

CoachAssistant CoachTeam ParentField MaintenanceI'm unable to volunteer at this time.
Consent/Waiver*

I/We consent to our child participating in the AIO Sport Programs. I understand that, like any sporting activity, my child is not without risk of injury. I permit my child to participate with full knowledge of this risk and will not hold the coaches or "AIO" responsible for any injury resulting from participation, accidental or otherwise. I understand that both Tidewater Adventist Academy and AIO Athletics and Recreation strongly recommends health/accident insurance for all its participants.
Medical History

All questions must be answered. Failure to disclose pertinent medical information may invalidate your insurance coverage and may cancel your eligibility to participate in the "AIO" program.

Has your child had any of the following? If yes, please provide details.
Head injury/concussion*

YesNo
If yes, please provide details:
Bone/Joint disorders, fractures, dislocations, trick joints, arthritis or back pain*

YesNo
If yes, please provide details:
Eye/Ear problems (disease/surgery)*

YesNo
If yes, please provide details:
Heat illness*

YesNo
If yes, please provide details:
Dizzy spells, fainting, or convulsions*

YesNo
If yes, please provide details:
Tuberculosis, asthma, bronchitis or other breathing issues*

YesNo
If yes, please provide details:
Heart trouble or Rheumatic fever*

YesNo
If yes, please provide details:
High/Low blood pressure*

YesNo
If yes, please provide details:
Anemia, Leuikemia, or other Bleeding disorder*

YesNo
If yes, please provide details:
Diabetes, Hepatitis, or Jaundice*

YesNo
If yes, please provide details:
Ulcers, Colitis, or other Stomach trouble*

YesNo
If yes, please provide details:
Kidney/Bladder problems*

YesNo
If yes, please provide details:
Hernia (rupture)*

YesNo
If yes, please provide details:
Mental illness/Nervous breakdown/Anxiety*

YesNo
If yes, please provide details:
Addiction to drugs/alcohol*

YesNo
If yes, please provide details:
Surgery (or advised to have surgery)*

YesNo
If yes, please provide details:
Taking medications regularly*

YesNo
If yes, please provide details:
Allergy/Skin problems*

YesNo
If yes, please provide details:
Menstrual problems*

YesNo
If yes, please provide details (including date of last period):
Any other important health related issues which were not mentioned above, including details:
Emergency Contact #1*

First NameLast Name
Phone Number for Emergency Contact #1*
Please enter a valid phone number.
Emergency Contact #2*

First NameLast Name
Phone Number for Emergency Contact #2*
Please enter a valid phone number.
Physician's Name*

First NameLast Name
Physician's Phone Number*
Please enter a valid phone number.
Please list any drug allergies
Please list any other allergies (including food/environmental)
Do you have any of the following (check all that apply)

AsthmaDiabetesEpilepsy
Please list all medications currently taking
Do you wear contacts?

YesNo
Release for Interview/Photography/Videography/Audio recording*

I grant permission to the "All in One Athletics and Recreation" program to interview, photograph, videotape and or audio record me or my child while participating in activities provided through "AIO" program. This grant of permission means that, in addition to other appropriate uses (which include, but are not limited to inclusion in or on "AIO" publications, promotional materials, advertisements, presentations, programs and Internet/Intranet sites), information obtained by me, as well as my name and likeness, may be used in conjunction with or by any medium, including print, electronic, radio, and television. By signing this release, I waive any cause of action I may have against the "AIO" program pertaining to the reproduction, publication, and/or use of information, and images obtained from me.
Waiver of Liability*

In consideration of being permitted to participate in any way in "All in One Athletics and Recreation" program, parent/guardian is required to attend all sessions with participant unless school or volunteer staff is attending. I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge and covenant not to sue the principals of "AIO" program and it's officers, owner, employees, volunteers from liabiltiy from any and all claims including the negligence of the principals of "AIO" it's officers, employees and agents, City of Virginia Beach resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to participation in the activity.
Assumption of Risks*

Participation in the activity carries with it certain inherant risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from (1) minor injuries such as scratches, bruises, and sprains, (2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions, to (3) catastrophic injuries, including paralysis and death. I hereby read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in the activity. I hereby assert that my participation is voluntary and that I knowingly assume all such risks and any medical responsibilities which my child my require.
Indemnification and Hold Harmless*

I also agree to indemnify and hold the principals of "AIO" officers, owner, employees, volunteers, agents harmless from any and all claims, actions, suits, procedures, cost, expenses, damages and liabilities, including attorney's fees brought as a result of my involvement in the activity and to reimburse them for any such expenses incurred.
Severability*

The undersigned further expressly agrees that the foregoin waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of Virginia and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
Acknowledgement of Understanding*

I have read the waiver of liability, assumption of risks, and indemnity agreement, fully understand its' terms and understand that I am giving up substantial rights, including my own right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.
Refund/Cancellation/Expiration Policy*

All training sessions or services must be purchased in advance. There are no refunds on session packages. Only individuals who cannot finish the sessions due to health issues accompanied by a written note from a physician are eligible for a refund for unused sessions minus a $25 processing fee. All sessions must be used in their entirety within two (2) months from the date of purchase. Any sessions remaining after a two (2) month period will be considered expired and non-refundable.
Participant Signature*

Clear
Parent/Guardian Signature*

Clear
Should be Empty: