Release Waiver Of Liability Page 2

well   a s   o ther   o fficial   p rinted   p ublications   w ithout   f urther   c onsideration.   I n   a ddition,   I   a cknowledge   S pooky   N ook   S ports’   r ight   t o   c rop   o r   t reat   t he  

media   a t   i ts   d iscretion,   a nd   I   a lso   a cknowledge   t hat   S pooky   N ook   S ports   m ay   c hoose   n ot   t o   u se   m y/our   i mage   a t   t his   t ime,   b ut   m ay   d o   s o   a s   i ts   o wn  

discretion   a t   a   l ater   d ate.  

I   a lso   u nderstand   t hat   o nce   I ,   o r   m y   f amily   m embers,   i mage(s)   h ave   b een   c aptured,   t hey   m ay   b e   p osted   o n   t he   S pooky   N ook   S ports   W ebsite   o r  

social   m edia   p latforms,   t he   i mage   c an   b e   d ownloaded   b y   a ny   c omputer   u ser   o n   o r   o ff   t he   p remises   o f   t he   S ports   C omplex.   T herefore,   I   a gree   t o  

indemnify   a nd   h old   h armless   f rom   a ny   c laims   t he   f ollowing:  

Spooky   N ook   S ports   c oaches   a nd   o ther   t eam   m embers  

•

Spooky   N ook   S ports   e mployees  

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Spooky   N ook   S ports   a lso   r eserves   t he   r ight   t o   d iscontinue   u se   o f   p hotos   w ithout   n otice.  

 

I  HAVE  READ  THIS  RELEASE  OF  LIABILITY  AND  PHOTOGRAPY  RELEASE,  FULLY  UNDERSTAND  ITS  TERMS,  UNDERSTAND  THAT  I  HAVE  GIVEN  UP  

SUBSTANTIAL  LEGAL  RIGHTS  BY  SIGNING  IT,  AND  SIGN  IT  FREELY  AND  VOLUNTARILY  WITHOUT  ANY  INDUCEMENT.  

 

___________________________________________      

 

_______      

_______/_______/___________    

PARTICIPANT’S  NAME  

 

 

 

 

AGE  

 

BIRTHDATE              

 

___________________________________________      

 

__________________________________________________________  

PARENT/GUARDIAN  NAME    

 

 

 

EMAIL  ADDRESS  

 

___________________________________________________________  

   

___________________________________________  

ADDRESS    

 

 

 

 

 

 

PHONE  NUMBER  

 

______________________________    

_____________________  

 

___________________________________________  

CITY  

 

 

 

 

STATE/ZIP  

 

 

SIGNATURE  

 

ORTHOPEDIC  ASSOCIATES  OF  LANCASTER  

CONSENT  FOR  EMERGENCY  ASSESSMENT  AND  TREATMENT    

BY  ATHLETIC  TRAINERS    

 

I   c onsent   t o   t he   p erformance   o f   e mergency   s ervices,   i ncluding   a ssessment   a nd   m anagement   o f   i njuries   a t   t he   S pooky   N ook   S ports  

Complex,   a s   m ay   b e   d eemed   n ecessary   o r   a dvisable   a nd   i n   a ccordance   w ith   p rotocols   e stablished   b y   p hysicians   o f   O rthopedics   A ssociates   o f  

Lancaster,   L td.     I   u nderstand   t hat   s ervices   a re   p rovided   b y   l icensed   a thletic   t rainers   o f   O rthopedic   A ssociates   o f   L ancaster.      

 

I   u nderstand   t hat   t he   l icensed   a thletic   t rainers   m ay   d etermine   t hat   I   n eed   t o   b e   r eferred   t o   a   p hysician   o r   a   h ospital   e mergency  

department   f or   f urther   a ssessment   a nd   t reatment   o f   m y   i njury.    

 

This   c onsent   f or   t reatment   i s   e ffective   u ntil   r evoked.  

 

 

_____________________________  

 

_______________________________    

 

Patient    

 

 

 

Date  

 

________________________________    

_______________________________  

Patient's  Legal  Representative  or  Guardian  

Relationship  to  Patient  

 

 

FOR  PARENTS/GUARDIANS  OF  PARTICIPANT  OF  MINORITY  AGE  

  ( Under   a ge   1 8   a t   t ime   o f   r egistration)  

 

This   i s   t o   c ertify   t hat   I   a m   t he   p arent   o r   g uardian   o f   t he   m inor   P articipant   n amed   a bove,   h aving   l egal   r esponsibility   f or   t his   m inor,   a nd   I   d o   h ereby  

consent   ( with   t he   a pproval   o f   m y   s pouse,   i f   a ny)   t o   t he   m inor’s   p articipation   i n   t he   A ctivities   a t   T he   N ook   a nd   a gree   t o   t he   R elease   o f   L iability   a s  

provided   a bove   a nd   h ereby   m ake   a nd   e nter   i nto   e ach   a nd   e very   r epresentation,   c ertification,   w aiver,   r elease,   a ssumption   a nd   i ndemnity   d escribed  

above   i n   t he   R elease   o f   L iability   o n   b ehalf   o f   m yself,   t he   m inor,   a ny   o ther   p arent   o r   g uardian   o f   t he   m inor,   a nd   o ur   h eirs,   a ssigns,   p ersonal  

representatives,   a nd   n ext   o f   k in.      

 

I   a gree   t o   g ive   u p   m y   r ights,   t he   m inor’s   r ights,   a nd   t he   r ights   o f   a ny   o ther   p arent   o r   g uardian   t o   m aintain   a ny   c laim   o r   s uit   a gainst   R eleasees   a rising  

out   o f   t he   m inor's   p resence   o r   p articipation   i n   t he   A ctivities   a t   T he   N ook.   I   b elieve   a nd   r epresent   t hat   I   H AVE   L EGAL   A UTHORITY   T O   M AKE   T HESE  

WAIVERS   A ND   R ELEASES,   a nd   I   a gree   t o   i ndemnify   a nd   d efend   t he   R eleasees   f or   a ll   l iability   a rising   o ut   o f   a ny   l ack   o f   a uthority   o n   m y   p art   t o   m ake  

such   w aivers   a nd   r eleases.  

 

_____________________________                     _ _________________________                       _ ______________  

PARENT/GUARDIAN  SIGNATURE                              (Print  name)  

 

 

               Date  signed