Liberty Athletics Participation Waiver
This waiver certifies that the athlete listed is physically capable and able to fulfill requirements needed to participate in all aspects of the LIBERTY ATHLETICS program and hereby give consent for him/her to participate in all aspects of LIBERTY ATHLETICS program. I Hereby release, discharge, hold harmless, covenant to indemnify and not to sue LIBERTY ATHLETICS, it’s directors, officers, employees, coaches, volunteers, managers, agents, sponsors, shareholders, and any associated personnel, from any and all liability to each of the undersigned, his/her heirs or next of kin for any and all against any claim by or on behalf of the participant as a result of participation in LIBERTY ATHLETICS program(s) and/or being transported to or from the same, which participation, after careful consideration I hereby authorize, and which transportation I hereby authorize. This release includes any claims of negligence, and is intended to be as broad as is permissible under New York State Law.
First Name
Last Name
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Phone Number
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Participant's Name
Participant's Date of Birth
List any medical conditions and or allergies
Emergency Contact Name & Number
Medical Release and Liability Waiver I, certify that the above is physically capable and able to fulfill requirements needed to participate in all aspects of the LIBERTY ATHLETICS program and hereby give consent for him/her to participate.
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