Clinic Registration Form
All information is required. For any questions, please reach out to us directly at info@shoot360frederick.com
Participant Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Participant Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
School Attending?
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Conditions or Allergies
Please describe any medical conditions or allergies we should know about.
*
Select Clinic Date
*
Please Select
Oct. 26 - Shooting Clinic (10am - 1pm)
Waiver and Release of Liability
*
Release and Disclaimer on Behalf of Minor I am the parent or legal guardian of the minor. As lawful consideration for being permitted to participate in the ENTER FACILITY HERE (“Shoot 360”) gym Shoot 360 activities, camp, and/or clinic, I, intending to be legally bound, agree and acknowledge that: 1. The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) to my child from the activities involved in these activities, camp or clinic are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and, 2. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child’s participation; and, 3. I willingly agree to comply with Shoot 360’s stated and customary terms and conditions for participation. If I observe any unusual or significant concern in my child’s readiness for participation and/or in the program/activities themselves, I will remove my child from the participation and bring such attention of the nearest company representative immediately; and, 4. I for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Shoot 360, its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event, activities, camp or clinic (“Releases”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these activities, camp or clinic WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 5. I agree that I for myself, my spouse, and my child, will not make a claim against, sue, attach the property of or prosecute Shoot 360 and their agents, sponsors and employees for damages for death, personal injury or property damage which my child may sustain as a result of his/her participation in these sporting activities, camp or clinic. 6. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releases from any and all liabilities incident to my and my child’s involvement or participation in these activities, camp or clinic, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. 7. I attest that my child is physically fit and has no known medical conditions which prohibit participation in this sport. 8. I, the parent/guardian, assert that I have explained to my child/ward: the risks of the activity, his/her responsibilities for adhering to the rules, guidelines and regulations, and that my child/ward understands this Agreement. 9. I understand and agree that I, on behalf of my child, am solely responsible for the mechanical and/or operating condition of any and all sporting equipment my child uses, and I agree to continuously inspect and maintain that equipment, even if I have obtained any of the equipment from Shoot 360, their agents, sponsors and/or employees. I, FOR MYSELF, MY SPOUSE, AND CHILD/WARD, HAVE CAREFULLY READ THIS RELEASE AND DISCLAIMER AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT..I also agree that SHOOT 360 and their agents, sponsors and employees may use my child’s photograph in future promotions and for public display on SHOOT 360 Leader Boards. UNDERSTANDING OR RISK I understand the seriousness of the risks involved in participating in this activity, camp or clinic, my personal responsibilities for adhering to rules and regulations, and accept them as a participant.
Name of Person Signing Waiver
*
First Name
Last Name
Participant/Parent or Guardian Signature
*
Are you interested in Shoot 360 Frederick membership?
*
Yes
No
My Products
prev
next
( X )
Clinic Member
Membership Price Verified
$55.00
$
55.00
Quantity
1
2
3
4
5
6
7
8
9
10
Clinic Non-Member
Non-Membership Price Verified
$65.00
$
65.00
Quantity
1
2
3
4
5
6
7
8
9
10
Register and Pay
Register and Pay
Should be Empty: