Tampa Bay Sprinters Speed Team

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SKATER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

* Birthdate:

Email:

Gender:

* Current Age:

PARENT/GUARDIAN #1

First Name:

Last Name:

EMail:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

First Name:

Last Name:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

WAIVER INFORMATION

* Parent/Guardian or Skater Name of Waiver Signing:

* I am at least 18 years old:

Yes

I hereby acknowledge that I am the parent/legal guardian of the above listed participant, who is a minor under the age of eighteen (“Minor Child”). In consideration for the benefits to be derived from My Minor Child’s participation in a Sport Club, I, on behalf of myself and my Minor Child, hereby acknowledge the following: (1) I am aware that all Sport Clubs involve risk; (2) I am aware that competing or practicing in any Sport Club will be a dangerous activity involving MANY RISKS OF INJURY; and (3) I UNDERSTAND THAT THE DANGERS AND RISKS OF COMPETING OR PRACTICING SPEED SKATING INCLUDE, BUT ARE NOT LIMITED TO DEATH, SERIOUS NECK AND SPINAL INJURIES, WHICH MAY RESULT IN COMPLETE OR PARTIAL PARALYSIS, BRAIN DAMAGE, SERIOUS INJURY TO VIRTUALLY ALL INTERNAL ORGANS, BONES, JOINTS, LIGAMENTS, MUSCLES, TENDONS, AND OTHER ASPECTS OF THE MUSCULAR SKELETAL SYSTEM AND SERIOUS INJURY OR IMPAIRMENT TO OTHER ASPECTS OF MY MINOR CHILD’S BODY, GENERAL HEALTH, AND WELL-BEING. On behalf of myself and my Minor Child, I further understand and acknowledge that the dangers and risks of competing in or practicing speed skating may result not only in injury, but serious impairment of my Minor Child’s future abilities to earn a living, to engage in other business, social, and recreational activities, and generally to enjoy life.
Because of the danger of participating in the above sport, I, both on my own behalf and on behalf of my Minor Child, acknowledge and understand the importance of following rules and regulations established by the Tampa Bay Sprinters Speed Team. My minor child hereby agrees to obey such rules, regulations, and instructions.
I further acknowledge that my Minor Child is in good physical condition and do not know of any condition or reason that my Minor Child should not participate in speed skating.
I RECOGNIZE AND ACKNOWLEDGE THAT TAMPA BAY SPRINTERS SPEED TEAM DOES NOT CARRY ANY TYPE OF ACCIDENT OR HEALTH INSURANCE POLICY OUTSIDE OF THE USARS MEMBERSHIP COVERAGE. I ALSO REALIZE THAT SPORTS INJURIES CAN BE CATASTROPHIC FOR THOSE WITHOUT PROPER MEDICAL COVERAGE.

On behalf of myself and my Minor Child, I HEREBY RECOGNIZE AND ASSUME ALL THE RISKS ASSOCIATED WITH MY MINOR CHILD COMPETING OR PRACTICING SPEED SKATING AND RELEASE THE TAMPA BAY SPRINTERS SPEED CLUB, ITS FACILITIES, THE COACHES, AGENT REPRESENTATIVES, AND VOLUNTEERS FROM ANY AND ALL OBLIGATIONS, LIABILITIES, CLAIMS, DEMANDS, COSTS, AND EXPENSES, INCLUDING ATTORNEY’S FEES, OR DEMANDS OF ANY KIND OF NATURE WHATSOEVER WHICH MAY ARISE OR IN CONNECTION WITH MY MINOR CHILD’S PARTICIPATION IN ANY ACTIVITIES RELATED TO TAMPA BAY SPRINTERS SPEED CLUB. The terms hereof serve as a release and assumption of risk for myself and on behalf of my Minor Child, as well as our respective heirs, estates, executors, administrators, and assignees.
In signing this agreement, or selecting “Accept Terms & Conditions” to electronically sign this agreement I acknowledge and represent that I have read and understand it; that I sign or select “Accept Terms & Conditions” to electronically sign it voluntarily and for full and adequate consideration, fully intending to be bound by the same; and that I am at least eighteen (18) years of age and fully competent.

I/we agree with the above *

* Electronic Signature (First and Last Name):

* Electronic Signature Date:

Signature:

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Annual TBS Club Member Fee - $50