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BALLERZ INDOOR LLC
PARTICIPANT WAIVER, RELEASE OF LIABILITY & ASSUMPTION OF RISK
Participant Information
Full Name:
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
Date
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Emergency Contact
Contact Name:
First Name
Last Name
Phone:
Format: (000) 000-0000.
Participation Type
Agreement & Liability Waiver
I understand that participation in indoor soccer involves inherent risks including collisions, falls, and othe r hazards that may result in injury or death.
I release and hold harmless Ballerz Indoor LLC, its owners, staff, referees, volunteers, and affiliates from I liability for injuries or damages arising from participation.
I certify I am physically capable of participation and authorize emergency medical care if necessary. I agree to follow all facility rules and staff instructions while participating.
I agree to follow all facility rules and staff instructions while participating.
I consent to photography or video taken during participation being used for promotional purposes.
Electronic Signature
Participant Signature:
Date
-
Month
-
Day
Year
Date
Minor Authorization (Required if participant under 18)
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