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Minor Registration and Waiver Form Name of Program for which you are registering:___________________________________________________________________ Name________________________________Address______________________________________City_____________ State_____ Zip_____________ DOB______________ Age________ Grade________ Phone(h)______________________ (c) __________________________________ Email_________________________________________________ I hereby give my child permission to participate in The Competitive Edge Program noted above. I also verify that my child is in good health and authorize the directors to act for me according to their best judgment in any emergency requiring medical attention. I also agree to hold harmless and indemnify the Competitive Edge, LLC, its employees, servants, and/or agents and frees the employees, servants or agents of liability for any injuries, illness or other claims other than those arising from acts of negligence due to acts of omission or commission during the aforementioned program. Further, I hereby grant full permission for event organizers to record any or all of my participation in these events for photos, video pictures, T.V, radio, videotapes, and other media known and to use them no matter by whom taken in any manner for publicity, promotions, advertising trade or commercial purposes without any reimbursement of any kind due to me or the need to pay any fee. _____________________________________________________________ Signature of Athlete, Parent or Guardian Date Please make Checks payable to: Jim Ronai’s Competitive Edge, LLC Web: wwwcespeed.com Call: 203 799-3343 or info@cespeed.com SEND THIS FORM WITH PAYMENT TO: Jim Ronai’s Competitive Edge, LLC -630 Ridge Road, Orange, CT 06477 |
Name of Program for which you are registering:___________________________________________________________________ Name________________________________Address______________________________________City_____________ State_____ Zip_____________ DOB______________ Age________ Phone(h)______________________ (c) __________________________________ Email_________________________________________________ I _____________________________ choose to participate in the The Competitive Edge Program noted above. I also verify that I am in good health and authorize the directors to act for me according to their best judgment in any emergency requiring medical attention. I also agree to hold harmless and indemnify the Competitive Edge, LLC, its employees, servants, and/or agents and frees the employees, servants or agents of liability for any injuries, illness or other claims other than those arising from acts of negligence due to acts of omission or commission during the aforementioned program. Further, I hereby grant full permission for event organizers to record any or all of my participation in these events for photos, video pictures, T.V, radio, videotapes, and other media known and to use them no matter by whom taken in any manner for publicity, promotions, advertising trade or commercial purposes without any reimbursement of any kind due to me or the need to pay any fee. _____________________________________________________________ Signature of Athlete/Participant Date Please make Checks payable to: Jim Ronai’s Competitive Edge, LLC Web: wwwcespeed.com Call: 203 799-3343 or info@cespeed.com SEND THIS FORM WITH PAYMENT TO: Jim Ronai’s Competitive Edge, LLC -630 Ridge Road, Orange, CT 06477 |