CERTIFICATION, WAIVER, INDEMNIFICATION, & MEDICAL TREATMENT AUTHORIZATION
IN CONSIDERATION OF my child being allowed to participate in any way in the LionHearted Sports, LLC related events and activities, the undersigned acknowledges, appreciates, and agrees that:
I hereby give permission for my child to participate in the activities of LionHearted Sports, LLC. I have read the information about LionHearted Sports, LLC and I am in support of my child’s participation.
I hereby grant LionHearted Sports, LLC and its legal representatives and assigns, the irrevocable and unrestricted right to use and publish my child’s first name and initial to last name and all image and personality rights, including film, photograph, tape or video reproduction (together, “Materials”) in which my child may be included, for editorial, trade, advertising, website marketing and any other purpose and in any manner and medium (now existing or hereafter developed); to alter the same without restriction; and to copyright the same. I hereby release LionHearted Sports, LLC and its legal representatives and assigns from all claims and liability relating to said Materials.
I hereby authorize LionHearted Sports, LLC to access data from the District as well as have access to and make copies of my child’s school records (grades, test scores, attendance, enrollment) through the completion of high school and into post-secondary education.
I further authorize LionHearted Sports, LLC to request, share and use all information held by LionHearted Sports, LLC and its partners relating to me, with all higher education institutions and programs partners for the purposes of enhancing my chances of graduating from college. This includes but is not limited to, personal information (such as my name, mailing address, email address and date of birth), high school and college academic information (such as high school courses, grades, test scores, college transcripts), financial information (such as any scholarships, financial aid, and grants awards to me), my recorded image and voice, and my applications, admissions, enrollment, attendance and academic status at higher education institutions (together, “My Information”).
LionHearted Sports, LLC monitor the progress of applicants and participants to better evaluate effectiveness of its high school and college program in light of its charitable mission. As part of the monitoring process, LionHearted Sports, LLC may share “My Information” with researchers and funders. I understand the LionHearted Sports, LLC will take appropriate steps designed to secure and protect this information, to keep it confidential, and to prevent others from connecting it to me. To the extent possible, except as set forth in this from, any information that could identify me will be removed or changes before such information is shared with other researchers, organizations, or institutions and before any research results are made public in an aggregated form.
Any waiver, modification or amendment of this will be effective only if acknowledged and agreed to by LionHearted Sports, LLC. Further, I understand that LionHearted Sports, LLC will maintain a record of this form, that I am entitled to request and receive a copy, and that I may wish to make a copy of this form for my own records. This form will be governed by and construed in accordance with the laws of the State of Texas.
IV. EXCULPATORY CLAUSE: In consideration for receiving permission for my/my child’s participation in any and all activities of the LionHearted Sports, LLC tour (herein referred to as “camp”), which is sponsored by LionHearted Sports, LLC, (herein referred to as “sponsor”), I hereby release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes sponsor, LionHearted Sports, LLC, and their members, officers, servants, agents, volunteers, or employees (herein referred to as RELEASEES or INDEMNITIES) from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney’s fees and expenses, that may be sustained by me/my child while participating in such activity, while traveling to and from the activity, or while on the premises owned or leased by RELEASEES, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct.
V. COVID 19 WAIVER LIABILITY: I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that LionHearted Sports, LLC has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19. I further acknowledge that LionHearted Sports, LLC cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, organization, staff, and other members and their families. I voluntarily seek services provided by LionHearted Sports, LLC and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19.
VI. * I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I have not traveled internationally within the last 14 days.
* I have not traveled to a highly impacted area within the United States of America in the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
* I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities. * I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
I hereby release and agree to hold LionHearted Sports, LLC harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the organization, or that may otherwise arise in any way in connection with any services received from LionHearted Sports, LLC. I understand that this release discharges LionHearted Sports, LLC from any liability or claim that I, my heirs, or any personal representatives may have against the organization with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from LionHearted Sports, LLC. This liability waiver and release extends to the organization with all owners, partners, and employees.
VII. INDEMNITY CLAUSE: I am fully aware that there are inherent risks to my child, myself and others involved with this activity, including but not limited to cuts and scrapes, dehydration/heat stroke, sprains, and unintentional collision injuries like broken bones, concussions, permanent injury or possible death, and I choose to voluntarily participate/ allow my child to in said activity with full knowledge that the activity may be hazardous to me, my child and my property, and to the person and property of others. I acknowledge there may be physically strenuous activities. I know of no medical reason why I/my child should not participate. I agree to indemnify and hold harmless INDEMNITIES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney’s fees and expenses, which may occur to myself, my child, other participants, and third-persons as a result of my/my child’s participation in said activity, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of INDEMNITIES.
VIII. NO INSURANCE: I understand that RELEASEES may or may not maintain any insurance policy covering any circumstance arising from my/my child’s participation in this activity or any event related to that participation. As such, I am aware that I should review my personal insurance coverage. Organization may not carry general liability insurance to cover claims arising from this activity so it seeks a waiver of claims as additional consideration for the right to participate so organization, can (a) provide the activity at the lowest possible cost to participants; and (b) provide access to a greater number of participants by expending limited resources on program materials rather than on liability insurance.
IX. MEDICAL AUTHORIZATION, INDEMNITY FOR MEDICAL EXPENSES, and WAIVER: I understand RE-LEASEES cannot be expected to control all of the risks articulated in this form and RELEASEES may need to respond to accidents and potential emergency situations. Therefore, I hereby give my consent for any medical treatment that may be required, as determined by a medical professional at the medical facility, during my/my child’s participation in this activity with the understanding that the cost of any such treatment will be my responsibility. I agree to indemnify and hold harmless INDEMNITIES for any costs incurred to treat me/my child. I further agree to release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes, RELEASEES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney’s fees and expenses, that may be sustained by me/my child while receiving medical care or in deciding to seek medical care, including while traveling to and from a medical care facility, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct.
X. VOLUNTARY SIGNATURE: In signing this agreement I acknowledge and represent that I have read it, understand it, and sign it voluntarily as my own free act and deed; sponsor has not made and I have not relied on any oral representations, statements, or inducements apart from the terms contained in this agreement. I execute this document for full, adequate and complete consideration fully intending to be bound by the same, now and in the future.