LIABILITY RELEASE AND WAIVER FORM GIVE A COPY OF THIS

LIABILITY RELEASE AND WAIVER FORM
GIVE A COPY OF THIS FORM TO EVERY PARTICIPANT
Every participant must have a completed and signed release form to turn in at registration at the door in order to participate.
Please use blue ink. Photocopies will not be accepted.
Minor’s Name __________________________________________________
Name of Parent or Legal Guardian ______________________________________
Address _______________________________________________________
School /Team Name _________________________________________________
City, State, Zip _________________________________________________
Division ___________________________________________________________
Phone Number (________) ________________________________________
Event Location ____________________________________________________
Email _________________________________________________________
[ ] Yes, you have my permission to send me updates / emails from Varsity!
Event Date_____________________________ Cheer [ ] Dance [ ]
Liability Release: For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, I ___________________________, as parent or legal
guardian of _______________________________________, a minor (hereinafter "Minor"), hereby grant the permission necessary to allow Minor to participate in the above Event
to be conducted by Varsity/USA, Inc. d / b / a United Spirit Association ("USA"). I, in my own behalf and on behalf of Minor, further agree to release and to hold harmless
Varsity/USA, Inc., Varsity Spirit’s Corporate Sponsors (hereinafter “Sponsors”), the Hosting site, (university, hotel, convention center, high school) on whose premises the Event
will occur (hereinafter the "Location"), the affiliates of Varsity/USA, Inc. and the Location, U.S. All Star Federation, Inc., a not for profit corporation (“USASF”), American
Association of Cheerleading Coaches and Administrators, Inc., a not for profit corporation ("AACCA") and the respective directors, officers, representatives, members, agents and
employees of Varsity/USA, Inc., Sponsors, and their respective affiliates (hereinafter collectively "Releasees") from any and all liability whether caused by negligence of the
Releasees or otherwise for any claim, judgment, loss, liability, cost and expenses (including, without limitations, attorney's fees and costs) arising out of or connected with the
Event, including any claim arising out of or connected with any illness or injury (minimal, serious, catastrophic and / or death) that Minor may incur or sustain during the Event,
all activities associated with the Event and while traveling to and from the site for the Event whether or not the Event actually occurs. I further expressly agree to indemnify and
hold harmless Releasees and Releasees' heirs, successors, assigns, executors and administrators against loss from any further claims, demands or actions that may subsequently be
brought by Minor or by any other persons on the account of damages of any character resulting to Minor in any way from the foregoing activities. I further agree to reimburse and
to make good to Releasees any loss or costs Releasees may have to pay as a result of any such action, claim or demand.
I, in my own behalf and on behalf of Minor, hereby warrant that I have read this Liability Release in its entirety and fully understand its contents. I, in my own behalf and on
behalf of Minor, am aware that this Liability Release releases Releasees from liability and contains an acknowledgement of my voluntary and knowing assumption of the risk of
injury or illness. I, in my own behalf and on behalf of Minor, further acknowledge that nothing in this Liability Release constitutes a guarantee that the Event will occur. I, in my
own behalf and on behalf of Minor, have signed this document voluntarily and of my own free will.
Signature of Parent or Legal Guardian: X___________________________________________________________ Date:_________________________________
Supervision: A chaperone/Adult (age 21 and over) is required to attend with participants. This Chaperone will be responsible for the participants at all times. Varsity/USA, Inc.
d/b/a/ USA, AACCA and USASF are not responsible for participants’ supervision..
Appearance Agreement: I understand that Varsity/USA, Inc. d / b / a USA from time to time produces promotional material relating to its programs. I understand that as
participant and/ or a spectator at the Event that Minor may be included in videotapes, dvds, podcasts and videocasts or photographs taken during the Event. Therefore, without
reservation or limitations, I, in my own behalf and on behalf of Minor, hereby assign, transfer and grant to Varsity/USA, Inc. d/ b/ a USA, its successors, assignees, licensees,
sponsors, any television networks, and all other commercial exhibitors the exclusive right to photograph and / or videotape Minor and to utilize such videotapes and photographs
and Minor's name, face likeness, voice and appearance as a part of the Event or in any other media now in existence or hereafter developed, in advertising and promoting the Event,
in advertising and promoting similar future events or in advertising and promotions relating to Varsity/USA, Inc. without reservations and limitations. I further understand that
neither Varsity/USA, Inc. nor any third party is under any obligation to exercise any of the foregoing rights, licenses and privileges.herein granted. I waive any right to inspect or
approve the programs, copies thereof and any promotional materials related thereto.
Medical Release: I, in my own behalf and on behalf of Minor, acknowledge and agree that such participation subjects Minor to possibility of physical illness or injury (minimal,
serious, catastrophic and/ or death) and that I, in my own behalf and on behalf of Minor, acknowledge that Minor is assuming the risk of such illness or injury by participating in
the event. In the event of such illness or injury, I authorize Varsity/USA, Inc. to obtain necessary medical treatment for Minor and hereby, in my own behalf and on behalf of
Minor, release and hold harmless Releasees in the exercises of this authority. I further acknowledge and understand that I will be responsible for any and all medical and related
bills that may be incurred on behalf of Minor for any illness or injury that Minor may sustain during the Event and while traveling to and from the site for the Event whether or not
the Event actually occurs.
I represent that any medication to which Minor is allergic or medications that Minor is currently taking are listed below. I agree that Minor shall bring medications which Minor is
currently taking with him / her to the Event and that he / she shall consume the prescribed dosage for such medications.
Medications (if any): ____________________________________________________________________________________________________________________
Allergic to (if any): _____________________________________________________________________________________________________________________
I acknowledge that the Minor suffers from the following conditions: ______________________________________________________________________________
I, in my own behalf and on behalf of Minor, hereby warrant that I have read this Participant Release and Waiver Form in its entirety and fully understand its contents. I, in my own
behalf and on behalf of Minor, am aware that this Participant Release and Waiver Form releases Releasees from liability and contains an acknowledgement of my voluntary and
knowing assumption of the risk of injury or illness. I, in my own behalf and on behalf of Minor, further acknowledge that nothing in this Participant Release and Waiver Form
constitutes a guarantee that the Event will occur. I, in my own behalf and on behalf of Minor, have signed this document voluntarily and of my own free will.
Minor and I understand that Sponsors may distribute samples of their products at the event.
Signature of Parent or Legal Guardian: X___________________________________________________________ Date:_________________________________
Relationship to Minor:__________________________________________________________
Minor Birthdate:_____________________________________
Minor SS#___________________________________________ (Not required but helpful for quick verification of insurance policy by hospital/clinic.)
I, identified above as Minor, acknowledge that I have read this Release and Waiver form.
Signature of Minor: X___________________________________________________________________________ Date: __________________________________
Regionals, Classics, Opens, Spirit Rallies, One-Day Clinics - 2013/14
As of 5/29/12