Under 18 Release and Consent Information

CERTIFICATION OF PHYSICAL FITNESS TO PARTICIPATE:

By checking the box and signing on the waiver, I, the legal guardian of the minor athlete, certify the following:

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 tell my child to obey all safety rules and to report fully any problems related to his or her physical condition to the coaches or assistants as soon as the problem begins

That my child is not currently under the care of a physician for an injury or illness that would prevent his or her safe participation in practice or competition

That my child is not currently being treated for or recovering from an orthopedic injury that would prevent his or her safe participation in practices or competition

That my child has no history of fainting or other problems related to strenuous exercise

That my child is in good health and there is no reason he or she cannot safely participate in strenuous physical activity.

Pole Liability:

By checking the box and signing on the waiver, I, the legal guardian of the minor athlete, certify the following:

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 have spoken with my child about 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/ my child.

CONSENT:

By checking the box and signing on the waiver, I, the legal guardian of the minor athlete, certify the following:

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

I hereby give consent to have myself/ my child 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 legal guardian of the minor athlete, certify the following:

In consideration for accepting my child 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 my child as a result of his or her participation in practice or competition. I also certify that I have health insurance, which provides adequate coverage for injuries or illness my child may sustain while participating in practice or competition.

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 child's 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.