Waiver and Informed Consent Agreement
The undersigned, being the natural or adoptive parents or legal custodians of:
____________________________________________________
Please Print Athlete’s Full Name
In consideration of my child’s participation in the activities of Elite Sports Ltd, I do hereby declare him/her to be
medically able to participate in the activities offered by Elite Sports Ltd.
I understand that there are risks that may include disabling injury and/or death involved in all physical activities. I
agree to familiarize myself with all equipment, facilities, rules and physical demands related to the activities
undertaken.
I agree to hold free from any and all liability Elite Sports Ltd and their respective officers, employees, members,
volunteers, and sponsors and do hereby for myself, my heirs, executors and administrators waive, and release and
forever discharge any and all rights and claims for damages which I may have or which may accrue to him/her
arising out of or connected with his/her participation in any of the activities of Elite Sports Ltd.
I have been appraised of and acknowledge the particular hazards and potential dangers in my child’s participation
in these activities.
Parent or Legal custodian’s Signature:
____________________________________________________ Date: ____/____/____
Emergency Procedure Information
____________________________________________________
Person to contact in Emergency: _________________________________
Home Phone (____) ____-______ Cell Phone (____) ____-______
Second contact in Emergency: _________________________________
Home Phone (____) ____-______ Cell Phone (____) ____-______
Please list any previous allergic reactions, serious injuries or special medical procedures:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
________________________________________________________________________
Hospital preferred. __________________________________________
Doctor: ____________________________ (____) ____-______
Dentist: ____________________________ (____) ____-______
I give my permission to the staff off Elite Sports ltd and their agents to secure a licensed physician in the case of an
emergency to provide the necessary care. I assume all financial obligations
Parent or Legal custodian’s Signature:
____________________________________________________ Date: ____/____/____
You can scan and email signed waiver to LThewes@EliteSportsOhio.com
or fax completed waiver to: (330) 497-1935