Above 18 Release and Consent Information

CERTIFICATION OF PHYSICAL FITNESS TO PARTICIPATE:

By checking the box and signing on the waiver, I, the listed athlete, certify the following:

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I understand that a risk of participating in any sport, including all track & field practice, is the risk of injury, including but not limited to serious permanent injury, paralysis, and death. To minimize the risk of injury, I agree to  obey all safety rules and to report fully any problems related to my physical condition to the coaches or assistants as soon as the problem begins

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That I am not currently under the care of a physician for an injury or illness that would prevent my safe participation in practice or competition

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That I am not currently being treated for or recovering from an orthopedic injury that would prevent my safe participation in practices or competition

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That I have no history of fainting or other problems related to strenuous exercise

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That I am in good health and there is no reason I cannot safely participate in strenuous physical activity.

 

Pole Liability:

By checking the box and signing on the waiver, I, the listed athlete, certify the following:

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I understand that QCVA purchases poles for the club to ensure the safest progression of poles for our members. This pole inventory is at the disposal of all club members and athletes are encouraged to use them if they do not have poles of their own.

 

I understand the importance of taking care of the vaulting poles and that they should not be used for anything other than their intended purpose.

 

I understand and agree to pay half of the replacement cost of a pole in the unfortunate circumstance of a club pole breaking as the result of myself.

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CONSENT:

By checking the box and signing on the waiver, I, the listed athlete, certify the following:

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I hereby give permission for QCVA, and its employees and agents to obtain medical treatment for me (Athlete listed in this form) in the event of accident or illness during my presence at training.

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I hereby give consent to have myself be photographed or video- or audiotaped during practice or competition activities, and I agree that the images so obtained may be used for educational and public relations purposes by QCVA.

 

RELEASE:

By checking the box and signing on the waiver, I, the listed athlete, certify the following:

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In consideration for accepting me into QCVA practices and competitions, I do hereby agree that I am and shall be responsible for all costs associated with any injury or loss that may be sustained by myself as a result of my participation in practice or competition. I also certify that I have health insurance, which provides adequate coverage for injuries or illness I may sustain while participating in practice or competition.

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I also agree to release and promise not to sue the State of Ohio, Queen City Vault Academy LLC, or their employees or agents, for any damages, loss, injury, or death arising from my participation in any practices or competitions, unless such damages, loss, injury or death are caused by the gross negligence or intentional gross misconduct of such employees or agents.