Jason Gesser Elite Sports

JASON GESSER ELITE SPORTS WAIVER FORM REGISTRATION-

Participant Name _______________________________________________________

Mailing Address ________________________________________________________

School you attend ____________________________________________Grade ______

Email Address:___________________________________________________________
IMPORTANT: Participants are required to bring this Registration form and the Authorization/Waiver/Consent form with you on the day of the event. You will not be authorized to participate in the event without this form.

Athlete Authorization, Injury Waiver & General Release Form:
As a participant in any of the Jason Gesser Elite Sports events, I acknowledge that participation in any 2009 Events exposes me to a possible risk of personal injury and death. I, hereby release Jason Gesser Elite Sports, Camp director’s, coaches, its officers, directors, employees, agents, licensees, subsidiaries, consultants, independent contractors and affiliates, from any and all liability from property damage, personal injuries or other claims arising from or in connection with my participation in the Event including claims that are known and unknown, foreseen and unforeseen, future or contingent. I covenant that I will not now or at any time in the future, directly or indirectly, commence or prosecute any action, suit or other proceeding against Company and its officers, directors, employees, agents, licensees, subsidiaries, consultants, independent contractors and affiliates, arising out of or relating to the actions, causes of action, claims and demands hereby waived, released or discharged by me. For good and adequate consideration, which I acknowledge I have received, I hereby grant, release, and quitclaim to Company the right and authority to use, sell, reproduce, and distribute, quoted material, biographical information, my photograph, likeness, recorded voice or videotaped filmed appearances (the “Materials”) for promotional and advertising purposes or programs as Company in its sole discretion will deem appropriate. I acknowledge that I have read and fully understand this Injury Waiver and General Release Form. This agreement will be binding on me, my spouse, my children, legal representatives, heirs, successors and assigns.
DATE: ____________

PRINTED NAME: ______________________________________________________

PARTICIPANT SIGNATURE:________________________________________________

ADDRESS:_____________________________________________________________________

CITY, STATE, ZIP:______________________________________________________________

EMERGENCY PHONE:______________________________
PARENTAL CONSENT (To be filled out if participant is under the age of 18)

The undersigned (”Parent”), parent of ____________________________ (”Subject”), hereby consent to affirm, and, on behalf of Subject, agree to be bound by the Injury Waiver and General Release Form attached here to which has been signed by Subject. Parents also represent, warrant and agree that Parents (is/are) entitled to the care and custody of Subject and (is/are) Subject’s legal guardian(s); that during the minority of Subject and for a reasonable time after wards, Parents will use all reasonable efforts to prevent Subject from attempting to or actually dis affirming the Injury Waiver and General Release Form signed by Subject; that Parents hereby acknowledge that Parents have read the Injury Waiver and General Release Form and are satisfied that it is fair and equitable for the benefit of Subject, and that Parents will not revoke this consent and approval.
DATE: _____________ SIGNATURE:___________________________________
NAME AND RELATIONSHIP TO SUBJECT: (please print)

NAME (PRINT): ____________________________________________

RELATIONSHIP: ____________________________
Make all payments to:Jason Gesser Elite Sports L.L.C.
This form must be printed & signed in full and presented the day of the Event.