Youth Training Program: February – May 2013 CONSENT FORM Name: (please print ) ____________________________ Mailing Address:________________________________________________________ Email Address:_________________________________________________________ Date of birth:___________________________________________________________ Emergency contact:__________________________________Phone:______________________
I (print name)______________________ consent to participate in the Okotoks Football Speed Training Program operated by Dan Mayhew on the following terms. 1. I understand that I will be undertaking physical exercise at or near the extent of my capacity and that there is possible risk in the physical exercise at that level. 2. I the undersigned, release Dan Mayhew from any claim whatsoever arising from any illness or injury to my person, including death or loss of property resulting from and arising from participation in the program. I understand clearly that by signing this release, I will be forever prevented from suing or otherwise claiming against Dan Mayhew and his ofďŹ cers, agents, and employees of any and for all claims, demands, rights, and causes of action of whatever kind or nature including but not limited to negligence, unforeseen bodily and personal injuries, damage to property, and the consequences thereof resulting from participation in any way connected with such recreational programs and activities of the training program. 3. I the undersigned, agree that at any point I feel as though I am unable to participate in the program due to injury or any physical or mental ailment that may put me or others at risk, I will notify my instructor immediately. 4. The undersigned understands that this Release, Covenant Not to Sue, Waiver, and Assumption of Risk shall be effective from the date of signature until the effective termination of the training services by Dan Mayhew. 5. By signing this document, the undersigned hereby acknowledges that he/she has read the above carefully before signing, and agrees to comply with all the above. Signature: ________________________________________ Date:______________ Signature of Parent/Guardian_______________________________Date:_________________ signature required if participant is 17 years old or younger:) Address and Phone:__________________________________________________________
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