Waiver and Release of Liability For Parent/Legal Guardian

Participant Name:

First NameLast Name

Doe's your youth have any medical conditions or dietary restrictions that we should be aware of to ensure their safety and well-being during the program?

I, the undersigned, as the parent/legal guardian of the above-named minor, hereby agree and understand that boxing is a contact sport and involves physical activity which contains an inherent risk of physical injury. In consideration of the participation in the "Gloves Not Guns" boxing program, I hereby release, waive, discharge, and covenant not to sue the organizers, administrators, directors, coaches, participants, supervisors, volunteers, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of the premises used to conduct the event (collectively the "releasees") from any and all liability to my child, his/her personal representatives, assigns, heirs, and next of kin for any loss, damage, or claim therefore on account of injury to the person or property of my child, whether caused by any negligent act or omission of the releasees or otherwise while my child is for any purpose participating in such program.

Media Consent: I grant the "Gloves Not Guns" boxing program and its agents the right to photograph, videotape, and/or record my child and to use his/her image, likeness, and sound of his/her voice as recorded on audio or video tape without compensation for any purpose in any medium (including broadcast via television, radio, and internet), and I understand that my child may be identifiable from such photographic or electronic reproduction.

As the parent/legal guardian, I agree to instruct my child regarding the following rules and expectations of the program:

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above.

I have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

PARENT/GUARDIAN’S SIGNATURE

Date Signed:

Date

Parent/Guardian Name:

First NameLast Name

Parent/Guardian Name:

First NameLast Name

Emergency Contact Number:

Format: (000) 000-0000.

WAIVER AND RELEASE OF LIABILITY

FOR PARTICIPANTS OF MINORITY AGE