2015 BJS Summer Strength and Conditioning Camp
June 8- August 7 2015
(fill in this form and return with payment to Coach Hanson)
Name:______
Date of Birth: ______Age:______
Graduating Class:______Sport 1______
Sport 2:______Ht.______Wt. ______
Parent(s)’ Name:______
Parent Cell Phone:______
Parent E-mail:______
Cost for the entire summer is $75
Sessions:
7:00-9:00 Football
8:00-10:00 Session 1______
8:15-10:15 Session 2______
8:30-10:30 Session 3______
8:45-10:45 Session 4______
10:00-12:00 Session 5______
10:15-12:15 Session 6______
10:30-12:30 Session 7______
If training with friends, list those who want to train at your time:
______
______
Payment Received:______Date: ______
I.In consideration of being allowed to participate in the personal fitness and sports performance training activities and programs of Athlete Development Center, Inc., and to use their facilities, equipment a, machinery and services, in addition to the payment of any fee or charge, I, being of full lawful age, do hereby forever waive, release, and discharge Athlete development Center, Inc., Bishop John Snyder High School, Bishop Estevez, and the Diocese of St. Augustine, and their officers, agents, employees, representatives, executors and all others acting on their behalf from any and all claims or liabilities for injuries or damages to my person and or property, including THOSE CAUSED BY ANY NEGLIGENT ACT OR OMISSION of any of those mentioned or others acting on their behalf, arising out of or connected with my participation in any activities, programs, or services of Athlete Development Center, Inc., Bishop John Snyder High School, Bishop Estevez, and the Diocese of St. Augustine, the use of any equipment at various sites including but not limited to, home or the facilities of Athlete Development Center, Inc., provided by and /or recommended by Athlete Development Center, Inc.
(Please Initial:______)
2.I have been informed of, understand and am aware that strength, flexibility and aerobic exercise, including the use of equipment and machinery, is a potentially hazardous activity. I also have been informed of, understand and am aware that fitness activities involve a risk of injury, including a remote risk of death or serious disability, and I am voluntarily participating in these activities and using equipment and machinery with full knowledge, understanding and appreciation of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury or death.
(Please Initial:______)
3.I do hereby further declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my full participation in these activities or use of equipment or machinery. I do hereby acknowledge that I have been informed of the need for a physicians approval for my participation in the exercise activities, programs and use of exercise equipment. I also acknowledge that it has been recommended that I have a yearly or more frequent physical examination and consultation with my physician regarding physical activity, exercise and use of exercise equipment. I acknowledge that either I have had a physical examination and have been given my physician’s approval to participate or I have decided to participate in the exercise activities, programs and use of equipment without my physician’s approval and do hereby assume all risks of and responsibility for my participation in said activities, programs, and use of equipment and machinery.
(Please Initial:______)
4.I ______(print name) have fully and wholly relied upon my own judgment in executing this release, and I have not been influenced to any extent whatsoever in making this release by any representations, or statements by employees or representatives of Athlete Development Center, Inc.
Signed ______
(athlete if over 18 or Parent on behalf of child)
Date ______