Waiver

 

In consideration of the acceptance of my application as a participant in the boxing program offered by Legacy Boxing Gym, and my use of that facility, I hereby agree to assume all risks attendant upon myself, any family member or those I am responsible for while participating in any and all programs at the Legacy Boxing Gym. I hereby waive, release, and discharge Legacy Boxing Gym, and their respective sponsors, employees, directors, agents, servants, and volunteers from any and all claims for death, personal injury, or property damage which I, any family member or those I am responsible may have, or which may hereafter accrue to me, as a result of our participation in any program at Legacy Boxing Gym. I agree to indemnify and hold harmless from Legacy Boxing Gym, and their respective sponsors, employees, directors, agents, servants, and volunteers by reason of any accident, death, injury, or damages, to persons or property which I, any family member or those I am responsible may suffer, while participating in any program at the Legacy Boxing Gym. This release is intended to discharge in advance Legacy Boxing Gym, and their respective sponsors, employees, directors, agents, servants, and volunteers by reason of any accident, death, injury, or damages, to persons or property which I or any family member or those I am responsible for may suffer, from and against any and all liability arising out of or connected in any way with my participation in any program at the Legacy Boxing Gym even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. I also understand the Legacy Boxing Gym, and their respective sponsors, employees, directors, agents, servants, and volunteers are not responsible for the monitoring or care of me, any family member or those I am responsible for outside of the gym facility, i.e. dropping off or picking of youth in the parking lot or any area outside of the gym facility.

It is further understood and agreed that this waiver, release and assumption of risk is binding on my heirs and assigns. I agree to assume all responsibilities for any property damage or injury to any person caused by me or any family member or those I am responsible while participating in any program at the Legacy Boxing Gym. I hereby also give permission for our images, captured during regular and special activities through video, photo and digital camera, to be used solely for the purpose of promoting the Legacy Boxing Gym. Legacy Boxing Gym has my permission to use these images from time to time in newsletters, reports, brochures, correspondence and/or the Legacy Boxing Gym websites, and I waive any rights of compensation or ownership thereto.

Please read and sign (parent or legal guardian must sign for athletes under 18). 

 
Athlete Name
Athlete Name
Parent/Guardian Name
Parent/Guardian Name
Address
Address
Phone
Phone
Birthdate
Birthdate
Physician/HMO Phone
Physician/HMO Phone
Emergency Contact (not listed above)
Emergency Contact (not listed above)