John Muir Health Ultimate Fieldhouse/Ultimate Sports Association
Consent, Release and Waiver
I the undersigned, am the above named individual or legal guardian for the individual. As an inducement for and in consideration of the agreement by Ultimate Sports Association to allow the above named individual (“Participant”) to participate in the athletic activities at the Ultimate Fieldhouse (“Activities”), the undersigned parent or legal guardian of the Participant hereby acknowledges and agrees as follows:
1. I have considered, understand and appreciate that there is a risk of serious and possibly permanent injury, including brain damage or death, to me as a result of my participation in the Activities and, I KNOWINGLY AND FREELY ASSUME THOSE AND ALL OTHER RISKS, known and unknown, related to my engagement in the Activities, including but not limited to RISKS ARISING FROM THE NEGLIGENCE OF OTHERS.
2. I consent to the provision of medical care, evaluation and treatment onsite at the Ultimate Fieldhouse by Ultimate Sports Association and Muir Orthopedic Specialists, and their respective, officers, employees, agents and contractors (collectively, “Onsite Providers”). I also consent to the provision of medically necessary diagnostic and therapeutic care, evaluation and treatment, including imaging, anesthesia administration, and surgery, at inpatient and outpatient facilities, including acute care hospitals, in the case of a medical emergency, or if I am unable to provide consent or my duly authorized attorney-in-fact-is unable to respond in a timely manner. I also consent to disclosures of legally protected medical information about me between (a) Onsite Providers, (b) Onsite Providers and the head coach and other duly authorized representatives of my team, and (c) between Onsite Providers and third parties in connection with the delivery of medical care and treatment to me. I will be and remain legally responsible to pay the cost of medical and dental care, evaluation and treatment furnished to me, other than the care, evaluation and treatment furnished by the Onsite Providers at the Ultimate Fieldhouse.
3. I hereby RELEASE and AGREE TO HOLD HARMLESS the Onsite Providers, and each of them, from and against any and all claims, demands, damages, causes of action or other liability arising from any injury or other loss or damage to person or property, known and unknown, that I may suffer directly or indirectly as a result of my participation in the Activities, EVEN IF SUCH INJURY, LOSS OR DAMAGE ARISES FROM THE NEGLIGENCE OF THE ABOVE RELEASED PARTIES OR ANY OTHER PERSONS, to the fullest extent permitted by law.
4. I grant full consent and permission for Ultimate Sports Association, Ultimate Fieldhouse, Muir Orthopedic Specialists, each of their affiliates and sponsors, and each of their respective officers, partners, managers, employees, and agents, to use, for any purpose whatsoever, including, without limitation, commercial purposes, the name, likeness, image, and voice of the Participant, as well as any photographs or recordings of any type of the Participant taken or made before, during or after the Activities.
5. I hereby irrevocably consent to and authorize the use by The Ultimate Fieldhouse and/or Ultimate Sports Association of any and all photographs, video, voice recordings, or other media taken of me including derivative works thereof (collectively, the “Images”), and any reproduction of them in any form in any media whatsoever, whether now known or hereafter created, throughout the world in perpetuity. I also consent to the use of my name or likeness, or an assigned fictitious name, in connection with the exhibition, distribution, merchandising, advertising, exploiting and/or publicizing of Images or The Ultimate Fieldhouse and/or Ultimate Sports Association. I hereby release and discharge The Ultimate Fieldhouse and/or Ultimate Sports Association, its trustees, officers, employees, licensees, and affiliates from any and all claims, actions, suits or demands of any kind or nature whatsoever, in connection with the use of Images and the reproduction thereof as aforesaid. I understand and agree that The Ultimate Fieldhouse and/or Ultimate Sports Association will be the exclusive owner of all rights, including, but not limited to, all copyrights, in and to the Images in whole or part, throughout the universe, in perpetuity, in any medium now known or hereafter developed, and to license others to so use them in any manner The Ultimate Fieldhouse and/or Ultimate Sports Association may determine in its sole discretion, without any obligation to me. I hereby waive any right that I may have to inspect and/or approve the use of the Images or any reproductions thereof, by The Ultimate Fieldhouse and/or Ultimate Sports Association. I hereby release and discharge The Ultimate Fieldhouse and/or Ultimate Sports Association.
I HAVE READ THIS CONSENT AND PERMISSION, RELEASE AND WAIVER. I UNDERSTAND THE TERMS OF THIS CONSENT, RELEASE AND WAIVER AND SIGN IT FREELY AND VOLUNTARILY.