THE SHOT FACTORY – WAIVER & CONSENT FORM
Complete all required fields and provide consents for participation in activities at The Shot Factory.
SECTION 1 – PARTICIPANT INFORMATION
Participant’s Full Name
First Name
Last Name
Participant’s Date of Birth
-
Month
-
Day
Year
Date
Level of Hockey
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Parent/Guardian #1 Full Name
First Name
Last Name
Parent/Guardian #1 Email Address
example@example.com
Parent/Guardian #1 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian #2 Full Name
First Name
Last Name
Parent/Guardian #2 Email Address
example@example.com
Parent/Guardian #2 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact
Emergency Contact Full Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Participant
SECTION 2 – ASSUMPTION OF RISK
I acknowledge that participation in off-ice hockey training, physical conditioning, and related activities at The Shot Factory involves inherent risks, including but not limited to: slips, falls, muscle strains, sprains, collisions with equipment or participants, and other injuries that may occur despite supervision and safe practices. I voluntarily accept and assume all such risks, known and unknown, even if arising from the negligence of The Shot Factory, its owners, directors, officers, employees, contractors, coaches, coaches-in-training, or volunteers.
SECTION 3 – RELEASE OF LIABILITY
In consideration of participation, I hereby fully release and discharge The Shot Factory, its owners, directors, officers, employees, contractors, coaches, coaches-in-training, agents, and volunteers (“Released Parties”) from any and all claims, demands, actions, or causes of action, whether in law or equity, arising out of any injury, loss, damage, or death that may occur while participating in activities at or associated with The Shot Factory, whether caused by negligence or otherwise.
SECTION 4 – INDEMNIFICATION
I agree to indemnify and hold harmless the Released Parties, including coaches and coaches-in-training, from any and all claims, liabilities, damages, costs, or expenses (including legal fees) brought by or on behalf of the participant, family members, or third parties arising from participation at The Shot Factory.
SECTION 5 – MEDICAL AUTHORIZATION
I authorize The Shot Factory staff, including coaches and coaches-in-training, to secure emergency medical treatment for the participant if deemed necessary, and I assume full financial responsibility for any medical services provided.
SECTION 6 – MEDIA CONSENT
I grant permission for The Shot Factory to photograph, film, or otherwise record the participant during training sessions and events. I authorize the use of these images and recordings for promotional, marketing, educational, or informational purposes in print, online, and social media, without compensation. I waive any right to inspect or approve the finished product or its use.
SECTION 7 – MEDICAL & ALLERGY DISCLOSURE / FITNESS CONFIRMATION
To the best of my knowledge, the participant is physically fit to participate in off-ice hockey training at The Shot Factory. I, the parent/guardian, confirm that the above-named child is in good physical health to participate in this activity. I have disclosed below all relevant medical information:
Previous Concussions
Heart/Lung Conditions
Broken bones / musculoskeletal injuries
Allergies
Other Medical Conditions
Current Medications
SECTION 8 – RULES & CODE OF CONDUCT
I acknowledge that the participant must follow all rules, safety protocols, and instructions from staff, coaches, and coaches-in-training while at The Shot Factory. Failure to do so may result in dismissal without refund.
SECTION 9 – PROPERTY & PERSONAL BELONGINGS DISCLAIMER
I understand that The Shot Factory is not responsible for loss, theft, or damage to personal property.
SECTION 10 – NO GUARANTEE OF RESULTS
I understand that "The Shot Factory" does not guarantee specific skill development, fitness results, or advancement in hockey. Individual progress depends on each player’s commitment, effort, and consistency both inside and outside of training sessions.
SECTION 11 – SEVERABILITY CLAUSE
I understand and agree that if any provision of this agreement is found unenforceable, the remaining provisions shall remain in full force and effect.
SECTION 12 – FINAL ACKNOWLEDGMENT OF UNDERSTANDING
I HAVE READ THIS AGREEMENT CAREFULLY, FULLY UNDERSTAND ITS TERMS, AND SIGN IT FREELY AND VOLUNTARILY. I AM AWARE THAT BY SIGNING THIS DOCUMENT I AM WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.
Signature (Parent/Guardian if under 18)
Submit Waiver and Consent
Submit Waiver and Consent
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