ABC YOUTH FOUNDATION REGISTRATION

PARENT / GUARDIAN INFORMATION

First Name Last Name
Phone Number
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Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
EMERGENCY CONTACT

First Name Last Name
EMERGENCY CONTACT'S NUMBER
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EMERGENCY CONTACT RELATIONSHIP
STATISTICAL INFORMATION

Black / African American or African OriginWhite / CaucasianLatino / Hispanic AmericanAsian / Asian AmericanPacific Islander / HawaiianMultiracial / Other
Primary Language Spoken at Home

EnglishSpanishOther
ABC YOUTH FOUNDATION LIABILITY WAIVER

In consideration of Any Body Can Youth Foundation granting my child the privilege of participating in ABC’s Boxing and tutorial program, I hereby covenant not to sue and agree to release, discharge, hold harmless and indemnify ABC Youth Foundation, its trustees, officers, affiliates, and board members (collectively ABC Youth Foundation) from and against any and all liability, claims, damages, actions, or causes of action whatsoever, for loss, damage or injury to person or property, including but not limited to, acts or omissions constituting negligence on ABC’s part, except for willful or wanton negligence or misconduct. I acknowledge that I have been advised of potential dangers inherent in the program and that I am personally responsible for and voluntarily assume the risks of injury or damage to person or property, except as limited above.

I hereby grant the ABC Youth Foundation the absolute and irrevocable right and unrestricted permission in respect to video footage,
photographic portraits or pictures that they have taken of me or in which I may be included with others, to use, reuse, publish and republish
the same in whole or in part, individually or in any and all media now or hereafter known, and for legal business purposes in connection with
ABC Youth Foundation whatsoever without restriction as to alteration; and to use ABC Youth Foundation’s name in connection therewith if
ABC Youth Foundation so chooses.
I hereby release and discharge ABC Youth Foundation from any and all claims and demands arising out of or in connection with the use of
the video or photographs, including without limitation any and all claims for libel or violation of any right of publicity or privacy.
This authorization and release shall inure to the benefit of the heirs, legal representatives, licensees, and assigns of ABC Youth Foundation.
I am of full age and have the right to contract my own name. I understand that if I am under the age of eighteen (18) my parent or legal
guardian will sign on my behalf. I have read the foregoing and fully understand the contents thereof. This release shall be binding upon me
and my heirs, legal representatives, and assigns.

ABC YOUTH FOUNDATION WAIVER FOR CLAIMS OF MEDICAL AUTHORIZATION
Medical Treatment: Should it be necessary for my child to have medical treatment while participating in this program, I hereby give The Foundation's personnel permission to use their judgment in obtaining medical service for the child and I give permission to the physician selected by the Foundation's personnel to render medical treatment deemed necessary and appropriate by the physician. I understand that the Foundation has no insurance covering such medical and hospital costs incurred for my child and, therefore, any cost incurred for such treatment shall be my sole responsibility.
Participation: I give permission for my child to participate in all activities and for ABC Youth Foundation, which may include walking to get lunch and/or working in the neighborhood clean-up effort, or field trips.
In consideration for being permitted to participate in the ABC programs, we agree to not sue, to assume all risks, and to release and hold harmless the Foundation, and any and all of its predecessors, successors, officers, directors, deacons, trustees, insurers, employees, managers, agents, volunteers, community organizations, administrators, heirs, attorneys, executors, assigns and/or related or affiliated business entities (collectively all of the above persons and entities shall be referred to as the "Released Parties" hereafter) who, through negligence, carelessness or any other cause, might otherwise be liable to us. Any dispute arising from Parent/Guardian or Minor's participation in the ABC Youth Foundation or this agreement shall be governed by California law and shall be adjudicated in Federal or State court in San Diego County, California.
I, the Parent/Guardian, do hereby agree to indemnify the Released Parties from any and all actions, causes of action, claims, demands, damages, costs (including attorneys' fees) expenses, liabilities, and charges, known or unknown (the "Liabilities") arising out of or in connection with claims and/or actions relating to or brought by or on behalf of the Minor, including without limitation, claims related to or arising out of the Minor's participation in the ABC programs. The undersigned have carefully read this Waiver and Release and fully understand its contents. The undersigned certifies that the undersigned Parent/Guardian is at least 18 years of age and is the legal guardian of the above-mentioned minor. The undersigned is aware that this is a RELEASE OF LIABILITY, COVENANT NOT TO SUE, and a contract between the undersigned and the persons and entities mentioned above and all of their respective officers, directors, employees, agents, and representatives, and the undersigned sign it of their own free will.
I have read and understood the foregoing statements agreeing to assume the responsibility stated and waive all claims indicated.
PARTICIPANTS LEGAL FIRST AND LAST NAME

First Name Last Name
PARENT / GUARDIAN INFORMATION FIRST AND LAST NAME

First Name Last Name
DATE mm/dd/yyyy
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