5meter WAVIER FORM
WAIVER AND RELEASE OF LIABILITY
Please fill out the NOTES section during check out if:
1.The camper should be restricted from any activity.
2. If the camper will be taking medication during camp, please indicate name of drug and dosage.
3. Please identify any medical condition or medical history that would require special attention.
I hereby certify that the named camper is in good health and fully able to participate in all activities of the Sports Camp and that I know of no restrictions, physical impairments, or any other facts, which in any manner limit his/her participation in such a program :
camper to receive emergency medical or surgical treatment and hospitalization if necessary. I understand that good faith attem pt will be made to contact me, or the emergency contact named above, before taking this action . I will be financially responsib le for any medical attention needed during camp or resulting from an injury received at camp. My medical insurance shall be the sole insurance coverage for any medical treatment. I further agree that my child can receive over the counter remedies. (Tyleno l , Sudafed, etc.) Please contact us if you DO NOT want your child to receive over the counter medications. I HAVE READ THE REGISTRATION PACKET AND FULLY UNDERSTAND OUR OBLIGATIONS STATED THEREIN A ND ALSO THE RIGHTS O F US SPORTS CAMPS, I NC., AND HERBY AGREE TO ACT IN ACCORDANCE. For good and adequate consideration, which I acknowledge I have received, I hereby grant , release , and quit claim to 5meter & USSC royalty free the right and authority to use, reproduce, and distribute, quoted material, my child’s photograph, likeness, recorded voice or videotaped filmed appearances (the "Materials") for promotional and advertising purposes as 5meter & USSC in its sole discretion will deem appropriate. I also grant 5meter & US Sports Camps, Inc. permission to give USA Water Polo & Nike, Inc. camper’s information for direct marketing purposes.
I further expressly agrees that in consideration of my minor child/ward being allowed to participate in this 5meter Water Polo Camp, its related events and activities, I, acknowledge, appreciate, and agree that:
1. The risk of serious injury from the sports activities involved in this program is always present due to the nature of the sport (s); and there are also risk of injury from such outside camper activities to which you may consent, and
2. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation; and
3. I willingly agree to comply with the program’s stated and customary terms and conditions for my child’s participation. If, however, I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from participation and bring such to the attention of the nearest official immediately; an d
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS THE CAMP, THE ENTITY OPERATING THE CAMP, 5METER WATER POLO CAMPS, US SPORTS CAMPS, INC., (USSC), NIKE, INC., AND THEIR OFFICERS, DIRECTORS, OFFICIALS, AGENTS , OWNERS AND/OR EMPLOYEES, AND ALL SUBSIDIARIES , OTHER PARTICIPANTS, SPONSORING AGENCIES, SPONSORS, ADVERTISERS, AND, IF APPLICABLE, OWNERS A ND LESSORS OF PREMISES USED FOR AC TIVITY (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, regarding my child and/or arising from his/her activities , WHETHER ARISING FROM NEGLIGENCE OF THE RELEASEES OR OTHERWISE, except for willful misconduct, or otherwise to the fullest extent of the law.
I HAVE READ THIS HEALTH FORM AND RELATED CERTIFICATIONS, THE RELASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND THEIR TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Agreement to Arbitrate Disputes
IN THE EVENT OF ANY DISPUTE PERTAINING T O ANY PROVISION OF T HIS AGREEMENT, OR PERTAINING TO THE SERVICES REND ERED PURSUANT TO THI S AGREEMENT, OR IN A NY WAY RELATED TO ATTENDANCE AT THIS C AMP, INCLUDING ANY CLAIM FOR PERSONAL IN JURY OR OTHER LOSS, INCLUDING ANY CLAIM AGAINST US SC, NIKE, INC., THE ENTITY OPERATING THE CAMP AND THEIR DIRECTORS , OFFICERS, OFFICIALS, AGENTS O R EMPLOYEES AND ALL SUBSIDIARIES, OWNERS, PARTNERS, JOINT VENT URERS, OFFICIALS , EMPLOYEES , OR AGENTS OF THE CAMP OR OF AN Y FOREGOING ENTITY, EACH PARTY HERETO AGREES TO SUBMIT TO BINDING ARBITRATION TO RESOLVE SUCH DISPUTE S, BY CLAIM FILED, BEFORE JAMS IN ORANGE COUNTY, CALIFORNIA, TO BE ARBITRATED HERE OR SUCH OTHER VENUE AS DEEMED APPROPRIATE BY THE JAMS ARBITRATOR, SUCH ARBITRATION TO PROCE ED UNDER THE JAMS RULES. In the event either party to this agreement incurs any expense as a result of the other party’s failure to comply with any provision of this agreement, the non - complying party shall be liable for reimbursement of any and all such expenses or attorney fees directly or indirectly related to failure to comply. In the event any legal action or proceeding occurs which is in any manner related to or pertaining to this agreement, attempting to challenge in a non - arbitral forum such as a court of law the validity or application of this agreement, the party who substantially prevails in that court or non - arbitral proceeding shall be entitled to receive reasonable costs of such action or proceeding including attorney’s fees. In the arbitration itself, each party shall bear its own attorneys’ fees. The following disclosures are intended to help you thoroughly understand the significance of agreeing to arbitrate any controversy, or claim, or issue in any controversy or claim which may arise be tween the undersigned client and the attorney:
A) ARBITRATION SHALL BE FINAL AND BINDING ON THE PARTIES. B) THE PARTIES HERETO A RE WAIVING THEIR RIGHT TO SEEK REMEDIES IN COURT, INCLUDING THE RIGHT TO JURY TRIAL.
C) PRE - ARBITRATION DISCOVER Y IS GENERALLY MORE LIMITED THAN AND DIF FERENT FROM COURT PROCEEDINGS. D) THE ARBITRATOR’S (S) AWARD IS NOT REQUIRE D TO INCLUDE FACTUAL FINDINGS OR LEGAL REASONING A ND ANY PARTY’S RIGHT TO APPEAL OR TO SEEK MODIFICATION OF RULI NGS BY THE ARBITRATOR (S ) IS STRICTLY LIMITE D. E) THE ARBITRATOR OR PA NEL OF ARBITRATORS WILL TYPICALLY INCLUDE AN ATTORNEY OR JUDGE, ACTIVE OR RETIRED.
BY REGISTERING, YOU ARE SIGNIFYING UNDERSTANDING AND ACCEPTANCE OF THE PROVISIONS OF THIS AGREEMENT.
I hereby certify that the above - mentioned participant is in good health and fully able to participate in all activities of the Camp. By completing the registration, I am stating that I am also aware of and accept the risk inherent in the program activity. By clicking and continuing to register for the camp, I agree as well to hold harmless and indemnify 5meter, US Sports Camps, Inc., NIKE, Inc., their officers, directors, owners, officials, agents and employees, and all subsidiaries from any and all liability, loss, damages, costs, refunds or expenses which are sustained, incurred or required out of the actions of my dependent in the course of the camp.