Audubon Archery Club

Audubon Archery Club

Audubon Park K-8 School
Name*

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Student Name*

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Student Age*
Allergies (if any)
Medical Release and Authorization
As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.Permission is also granted to Gregory Archery and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.Release authorized on the dates and/or duration of the registered season.This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.*

Authorize
I am the legal guardian & am legally allowed to sign this waiver on behalf of my child.

GREGORY ARCHERY

Business Address: 2913 Mulford Ave. Winter Park, Florida 32789 321-316-8452
WAIVER AND RELEASE OF ALL CLAIMS BY CLIENT
I, (the "Client"), hereby agree that I have read and understood the terms of this agreement. I represent that I have advised GREGORY ARCHERY (by and through its employees, instructors, owners, agents, or independent contractors) of any medical condition, physical condition, or limitation that should be taken into account before beginning an exercise or lesson. In exchange for the services to be rendered by GREGORY ARCHERY (by and through its employees, instructors, owners, agents, and independent contractors), I further agree as follows:*
Client Name
1. I am an adult over the age of 18 and wish to participate in an exercise, lesson, class, game, program, or service rendered and/or taught by GREGORY ARCHERY (including its employees, instructors, owners, agents, and independent contractors In addition, I give permission for my children, identified below, to participate in program activities, lessons, exercises, games, or classes with GREGORY ARCHERY (including its employees, instructors, owners, agents, and independent contractors):
Child's Name*
Date of Birth*

MonthDayYear
Date
Second Child's Name
Second Child's Date of Birth

MonthDayYear
Date
I understand and expressly agree that GREGORY ARCHERY (including its employees, instructors, owners, agents, and independent contractors) shall not be liable for any injuries or damages to Client or Client's children (identified in Section 1, above), or be subject to any claim, demand, injury, or damages whatsoever, including without limitation those damages arising out of facts of passive or active negligence on the part of GREGORY ARCHERY (including its employees, instructors, owners, agents, and independent contractors I agree that by signing this agreement, I expressly and forever release and discharge GREGORY ARCHERY (and its employees, instructors, owners, agents, and independent contractors) from all such claims, injuries, damages, actions or causes of action. I further acknowledge that I have carefully read this agreement in its entirety and understand that it is a voluntary waiver and release of liability.
Client Name*
Date*

MonthDayYear
Date
Client Name
Date

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Date
Client Signature*

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My Products*

Audubon Archery ClubSession One: Sep 12-Oct 17 (6 weeks)

$150.00 Quantity

Audubon Archery ClubSession Two: Oct 24 - Dec 5 (6 weeks)

$150.00 Quantity

Audubon Archery ClubSession Three: Dec 12 - Jan 30 (6 weeks)

$150.00 Quantity

Audubon Archery ClubSession Four: Feb 6 - April 10 (8 weeks)

$200.00 Quantity

Total

$0.00

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Medical Release and Authorization

WAIVER AND RELEASE OF ALL CLAIMS BY CLIENT