CROSSNASTICS REGISTRATION FORM AND WAIVER

PARTICIPANT'S INFORMATION

Name*

Age*

DOB*

Gender*

Class*

Name

Gender

Age

DOB

Class

Name

Gender

Age

DOB

Class

Address*

City*

State*

Zip Code*

How did you hear about us?*

PARENT'S INFORMATION

Parent Name*

Parent E mail*

example@example.com

Parent Cell*

Parent Name

Parent E mail

example@example.com

Parent Cell

In case of EMERGENCY, Please contact*

Emergency Contact Telephone Number*

Relationship to participant *

Physical Information: Be sure to list any current/previous accidents, illness and/or physical limitations that would stop/prevent your registered child from participating in the obove program, otherwise state "NONE"

Allergies*

Medications*

Prior Medical Conditions*

Physical Limitations or Situation*

ASSUMPTION OF RISK: please initial *

Assumption of Risk Inconsideration of participating in T2SF. I represent that l understand the nature of this Activity and that and (if participating) my child or ward am/is qualified in good health and in proper physical condition to participate in such Activity. acknowledge that if believe event conditions are unsafe. will immediately discontinue participation in the Activity. fully understand that this Activity involves risks of serious bodily injury. including permanent disability. paralysis and even death which may be caused by my own actions, or inactions those of others participating in the event the conditions in which the event takes place. or the negligence of the "Releasees" named below, and that there may be other risks either not known to me or not readily foreseeable at this time: and fully accept and assume on my own and/or my child's or ward's behalf all such risks and responsibility for losses, cost. and damages or my child or ward incur as a result of participation in the Activity.

RELEASE AND LIABILITY: please initial *

I hereby release, discharge and covenant on my own and/or my child's or ward's behalf not to sue T2SF, its respective administrators, directors, agents, officers, volunteers and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the Activity takes place, (each considered one of the "Releasees" herein) from all liability, claims, demands, losses or damages, on my account caused or alleged to be caused in whole or in part by the negligence of the "Releasees" or otherwise, including negligent rescue operations and further agree that if, despite this release, waiver of liability, and assumption of risk, I, my child or ward, makes claim against any of the Releasees I, and on behalf of my child or ward, will indemnify, save, and hold harmless each of the Releasees from any loss, liability, damage, or cost, which any may occur as the result of such a claim.T2SF reserves the right to use any video or photographic material for any legal purposes.

MEDICAL EMERGENCIES: please initial *

I hereby give permission for certified and licensed medical personnel to use appropriate procedures to aid me, my child, or ward and prevent further injury and/or death. If possible, I wish to be contracted before any procedures are initiated, however, if the injuries are catastrophic, life threatening or I am unable to be reached, I give permission to the emergency care physicians, support personnel, and T2SF to do what they deem necessary in the best interest of me, my child or ward.

PHOTO/VIDEO RELEASE: please initial *

I hereby grant T2SF permission to use my photograph/video imagine in any and all publications for T2SF, including their websites, social media or publications without payment or any other consideration in perpetuity. I hereby authorize T2SF to edit, alter, copy, exhibit, publish or distribute all photos and video images. I waive the right o inspect or approve the finished product, including written or electronic copy, wherein my photo appears. Additionally, I waive any right to royalties or other compensation arising or related to use of the photograph or video images.

Date*

Date

TWENTY2SIX

PARTICIPANT'S INFORMATION

PARENT'S INFORMATION