Waiver - Fusion Athletics

Waiver and Release of Liability and Hold Harmless Agreement

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Parent or Guardian Name*

First Last

Phone*

Email*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Participant's Name*

First Last

Participant's Date Of Birth*

Parent Consent to Participate*

I agree to the participation waiver.

MEDICAL EMERGENCY:
The undersigned gives permission to Fusion Athletics LLC, its owners and operators to seek medical treatment for the participant in the event they are not able to reach a parent or guardian. I hereby declare any physical/mental problems, restrictions, or condition and/or declare the participant to be in good physical and mental health.

PHOTO VIDEO RELEASE MARKETING AND ADVERTISING:
During times photographs and videos will be taken during classes, events, and other activities. I agree that Fusion Athletics LLC, shall retain all rights for publicity and/or advertising purposes all photographs and/or videos of participants taken at any/all events or activities that may include your child.

RELEASE OF LIABILITY:
As the legal parent or guardian, I release and hold harmless Fusion Athletics LLC, Talon Harper, its owner and staff from any and all liabilities, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, to the participant and/or the undersigned, while in or upon the premises or any premises under the control and supervision of Fusion Athletics LLC, Talon Harper, its owner, directors, and staff, in route to or from any of said locations, and at any events/performances. In the event any party acquires the services of an attorney, all fees and court cost will be the sole responsibility and paid in full by the athlete/athlete's parent/guardian.

ASSUMPTION OF RISK:
I completely understand and agree that there are risks associated with participation in classes at Fusion Athletics LLC, Talon Harper, which could result in bodily injury, partial and/or total disability, and death. I accept such risks and responsibility for the losses and/or damages following such injury, disability, or death, however caused and whether caused in whole or in part by the negligence of Fusion Athletics LLC, its owner, Director, and staff. I release Fusion Athletics LLC, Talon Harper, All directors and staff on the premises; or at any event held by or attend by Fusion Athletics LLC.

Signature*

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