EVOLVE PLAY | TRAIN SPRING SPORTS CLUB FORM 2024

DATE*

Date

SELECT CLUB DATES

March 18 - 22, 2024 Full Week Sports Camp (Kindergartens to Grade School)March 25 - 28, 2024 Full Week Sports Camp (Kindergartens to Grade School)March 18 - 22, 2024 AM HALF DAY Sports Camp (Preschool Ages)March 18 - 22, 2024 PM HALF DAY Sports Camp (Preschool Ages)Other

CHILD's FULL NAME*

First NameLast Name

AGE*

Date of Birth*

Date

NAME OF PARENT/GUARDIAN #1*

Phone Number *

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

NAME OF PARENT/GUARDIAN #2*

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

NAME OF EMERGENCY CONTACT*

First NameLast Name

PHONE NUMBER*

RELATIONSHIP*

Name*

First NameLast Name

PHONE*

Name*

First NameLast Name

PHONE*

Name*

First NameLast Name

PHONE*

CHILD'S NAME*

CARE CARD NUMBER*

Physician's Name*

Physician's Phone #*

My child has the following medication conditions or allergies that may affect him/her in participating in our sports program or that may affect medical care authorized below: (If no conditions or allergies, mark with the word "None" and your initials*

In the event neither parent nor the doctor listed above can be contacted, I hereby authorize Evolve PLAY|TRAIN to obtain emergency medical care for my child when such medical care will be for the best interested of the child and should not be delayed pending consent of the parents for family doctor.

I provide permission to Evolve PLAY | TRAIN, their successors, their assignees the right to record the image and/or voice of my child, on videotape, on film, on photographs, in digital media and in any other form of electronic or print medium and to edit such recording at their discretion. I understand that my child’s full name, address and biographical information will not be made public. I further grant to Evolve PLAY | TRAIN, their successors, their assignees the right to use, and to allow others to use, my child’s image and/or voice on the internet, in brochures, and in any other medium and hereby consent to such use. I hereby release to Evolve PLAY | TRAIN, their successors, their assignees and any using my child’s image and/or voice, artwork, and/or written work pursuant to this media release form any and all claims, damages, liabilities, costs and expenses which I or my child now have or may hereafter have by reason of any use thereof. I understand that the provisions of this release are legally binding.*

YES to photos/ videos of my child aloneNO to photos/ videos of my child aloneYES to group photos/ videosNO to group photos/ vidoes

Release and Waiver of Liability

In consideration of the use of the all the facilities and equipment from Evolve PLAY | TRAIN, I acknowledge the following:
 I assume all risk to my child of injury, death or property loss resulting from any cause whatsoever arising out of or in connection with my child’s participation or use of the different sports equipment and climbing wall including but not limited to the inherent risks of participating in sports as well as climbing, the use of Evolve PLAY | TRAIN facilities, collision with natural or man-made objects or other persons or
travel within or near Evolve PLAY | TRAIN facilities including injury loss or damage which may have been contributed to or occasioned by the negligence of Evolve PLAY | TRAIN, its employees servants, agents, event organizers or property owners.
 Evolve PLAY | TRAIN shall not be liable to my child, myself, my heirs, executors, administrators and assigns for any loss or damage on account of personal injury, death, or property loss or damage whether caused by negligence of my child or another person using the facility, employees, servants, agents, of Evolve PLAY | TRAIN, event organizers or property owners and I hereby release Evolve PLAY | TRAIN its employees, servants, agents and event organizers and property owners
and waive any and all claims with respect thereto.
 Evolve PLAY | TRAIN, its employees, servants, and agents, event organizers and owners of the property WILL BE INDEMNIFIED AND SAVED HARMLESS BY MYSELF from and against all claims, actions and demands made by or on behalf of myself or any other person in respect to any injury, loss or damage of all and every description whatsoever arising out of or in connection with my use of the
climbing wall.
 I hereby give permission for my child to partake in the different sports and use of Evolve PLAY | TRAIN facilities
 I hereby gives permission for Evolve PLAY | TRAIN to authorize emergency medical treatment as may be deemed necessary for the Child/Children named below while participating in activities at the Facility.
The undersigned hereby releases, discharges, covenant to bring an action and agrees to indemnify and save harmless Evolve PLAY | TRAIN from all liability, claims, demands, losses or damages on the Child’s/Children’s account caused or alleged to have been caused in whole or in part by the negligent
medical treatment, failure to provide medical treatment, and further agree to indemnify, save and hold harmless Evolve PLAY | TRAIN and its Representatives from any liability whatsoever as a result of any such claim.
 I assume all responsibility for my child’s actions in the event his/her actions cause damage or injury to persons, employees or property within the Evolve PLAY | TRAIN facility
 I am signing this INDEMNIFICATION, RELEASE OF ALL CLAIMS AND WAIVER OF LIABILITY freely and voluntarily and I have read this entire agreement before signing it. Parental Release, Waiver and Indemnity I am executing this release, waiver and indemnity freely and voluntarily without any compulsion on the part of Evolve PLAY | TRAIN.

I further acknowledge having read this entire agreement prior to signing it. INTENDING TO BE LEGALLY BOUND.

Parent/Guardian Name*

Parent /Guardian Signature*

Date*

Date

EVOLVE PLAY | TRAIN SPRING SPORTS CLUB

REGISTRATION FORM

NAME AND PHONE NUMBER(S) OF PERSON(S) OTHER THAN PARENTS ALLOWED TO PICK UP YOUR CHILD

MEDICAL RELEASE FORM