AIO Sports Registration

AIO Sports Registration

AIO Sports Registration

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

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
School Attending
Course Selection
Parent/Guardian Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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
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
If yes, please provide details:
Bone/Joint disorders, fractures, dislocations, trick joints, arthritis or back pain
If yes, please provide details:
Eye/Ear problems (disease/surgery)
If yes, please provide details:
Heat illness
If yes, please provide details:
Dizzy spells, fainting, or convulsions
If yes, please provide details:
Tuberculosis, asthma, bronchitis or other breathing issues
If yes, please provide details:
Heart trouble or Rheumatic fever
If yes, please provide details:
High/Low blood pressure
If yes, please provide details:
Anemia, Leuikemia, or other Bleeding disorder
If yes, please provide details:
Diabetes, Hepatitis, or Jaundice
If yes, please provide details:
Ulcers, Colitis, or other Stomach trouble
If yes, please provide details:
Kidney/Bladder problems
If yes, please provide details:
Hernia (rupture)
If yes, please provide details:
Mental illness/Nervous breakdown/Anxiety
If yes, please provide details:
Addiction to drugs/alcohol
If yes, please provide details:
Surgery (or advised to have surgery)
If yes, please provide details:
Taking medications regularly
If yes, please provide details:
Allergy/Skin problems
If yes, please provide details:
Menstrual problems
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.Format: (000) 000-0000.
Emergency Contact #2

First NameLast Name
Phone Number for Emergency Contact #2
Please enter a valid phone number.Format: (000) 000-0000.
Physician's Name

First NameLast Name
Physician's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please list any drug allergies
Please list any other allergies (including food/environmental)
Do you have any of the following (check all that apply)
Please list all medications currently taking
Do you wear contacts?
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
Severability
Acknowledgement of Understanding
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
Parent/Guardian Signature
Should be Empty: