FACILITY REGISTRATION AND ASSUMPTION OF RISK AGREEMENT

PLEASE READ CAREFULLY BEFORE SIGNING. Completed waivers must be signed and returned with registration or prior to first attending QSLA training facility.

PART A: MEMBER INFORMATION

Player Name (Last Name, First Name)

Birthdate (mm/dd/yyyy)

Player Address

Player Email Address

Player Cell Phone

Player School

Does the player have any accessibility needs? Please specify.

PART B: EMERGENCY INFORMATION

Emergency Contact #1 (First Name, Last Name)

Cell Phone #

Relationship

Emergency Contact #2 Name (First Name, Last Name)

Cell Phone #

Relationship

Arrival and Dismissal

An adult will pick up the player from the program each day

Yes

The player may travel to and from the facility independently

Yes

PART C: MEDICAL

Does the player have any allergies?

Yes

If yes, please describe the allergic reaction and the treatment for each allergy. (write NA if not applicable)

Does the player take any medications?

Yes

If yes, please state the name of the medication/reason

Will the medication be needed at BallMatics Academy?

Yes

Not applicable

If yes, please explain (ex. asthma puffer may be needed, can be found in player's bag, side pocket)

PART D: RELEASE AND ASSUMPTION OF RISK AGREEMENT

I am the parent/legal guardian of player named in this document (the "Participant"), who desires to participate in programs, events, training, games or activities (each, a "Program") at BallMatics Academy in Toronto, Ontario ("QSLA"). On behalf of the Participant, myself, and anyone else who may make any claim for or on behalf of the Participant, I hereby irrevocably and unconditionally:

Represent and warrant that the Participant is in good health and physical condition and can participate in the Program, and acknowledge and understand that participation in or attendance at the Program involves certain risks and dangers of accidents, serious personal and bodily injury, including death, and property loss or damage either specifically as a result of participation in the Program or related transportation. I understand, have considered and evaluated the nature, scope, and extent of the risks involved, and I voluntarily and freely choose to assume these risks and to submit this Release and Assumption of Risk Agreement (the “Waiver”);
Fully and forever release, discharge and indemnify QSLA and QSLA's program partners, sponsors, funders and donors ("Partners"), and each of their parent companies, affiliates, subsidiaries, directors, officers, employees, agents, insurers, assigns and successors, together with all Program directors, volunteers, staff, coaches, training and medical personnel (collectively, the “Released Parties”) of and from any and all causes of action, lawsuits, losses, damages, injuries (including death) howsoever occurring, whether by negligence or otherwise, claims, demands, sums, costs, expenses (including legal fees), and any other liability of any kind, of or to me or the Participant or any other person, arising out of or in connection with the Program, including, without limitation, participation of the Participant in the Program or Program-related transportation;
Agree not to initiate any lawsuit, court action or other legal proceeding against the Released Parties, nor join or assist in the prosecution of any claim for money damages, which anyone may have, on account of loss, damage or injury sustained by me, the Participant or others howsoever occurring, whether by negligence or otherwise in connection with the Program and I waive any right to do so. This means that I cannot sue or hold the Released Parties responsible for any loss, damage, or injury that I or the Participant may experience related to the Program including, without limitation, transportation;
Waive my insurers’ right to make a claim against the Released Parties based on insurance payments made to me or on my behalf for any reason. This means my insurers have no right of subrogation;
Agree to hold harmless, indemnify and reimburse the Released Parties from and for any sums, costs, or expenses (including legal fees) incurred or suffered by any of the Released Parties or paid by them to any person (including me or my insurers) in connection with any accident, loss, damage, or injuries (including death), howsoever occurring, whether by negligence or otherwise, claims, demands, lawsuits, expenses and any other liability of any kind, sustained by me or others in connection with the Participant’s participation in the Program. This means that I will reimburse the Released Parties if anyone makes a claim against them based on damages or injuries the Participant suffers;
Understand that the Released Parties do not provide any insurance, whether life, medical or liability, for any illness, accident, injury, loss, or damage that may arise in connection with Participant’s participation in and attendance at the Program. If I want insurance of any kind on behalf of the Participant, I must obtain my own. I will pay my own medical emergency expenses and all subsequent medical expenses in the event of any illness, accident, or injury in connection with the Program;
Acknowledge that if any portion of this Waiver is held to be invalid or unenforceable, all other provisions shall nevertheless continue to be valid and enforceable. This Waiver supersedes any oral or written statements made by or to me or the Participant in connection with the Program. I understand that I cannot terminate, cancel or revoke this Waiver for any reason;
Agree that, in the event that I cannot be reached in a medical emergency, I hereby authorize and permit the Program or QSLA personnel to administer first aid to the Participant, and to authorize such other medical treatment and transportation as may be recommended by physicians, paramedics, and other medical personnel, in the event of any illness, accident or injury to the Participant;
Give and grant perpetually to QSLA and its affiliates employees, agents and Partners the irrevocable right (including, without limitation, all now and hereafter existing common law, statutory and moral rights) to use the name, address, photograph, image and likeness, and voice of the Participant (the “Attributes”) for publicity purposes, commercial or otherwise, in any media without compensation or further notification including, without limitation, the perpetual and unlimited right to reproduce any materials produced by QSLA incorporating the Attributes, and the complete and unencumbered right throughout the world, to exhibit, record, reproduce, broadcast, transmit, publish, sell, distribute, perform and use for any purpose, in any manner, by any means and in any medium, all or any part of the matter and things referred to in this paragraph. I acknowledge that neither I or the Participant shall have any right, title or interest in or to any materials produced hereunder incorporating the Attributes;
Further agree that this document is governed by the laws of Ontario and operates to the benefit of the Released Parties as well as their administrators, successors and assigns, and is binding on me and my heirs, administrators, successors, assigns, insurers and estate.

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BY SUBMITTING THIS FORM I ACKNOWLEDGE I HAVE READ THIS WAIVER CAREFULLY. I FULLY UNDERSTAND ITS CONTENT, AND VOLUNTARILY AGREE TO ITS TERMS. BY SIGNING THIS WAIVER, I UNDERSTAND THAT I, ON BEHALF OF MYSELF AND THE PARTICIPANT, AM WAIVING CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.