www.olympiaathletic.com

ONLINE LIABILITY/WAIVER RELEASE AGREEMENT

Welcome to the online form for the OLYMPIA'S Liability/Waiver Release Agreement. 
 
Please complete the online form below and agree to all terms and conditions. This form will be valid for the participant until JUNE 1, 2020. All activities that the particiapant engages in between the date of this agreement is submitted and 6/1/2020 are covered, there is no need to submit multiple agreements.

If you have any questions, please contact us at...

E-Mail: info@olympiaathletic.com
Phone: (636) 329-4949

Thank You For Your Support!

PARTICIPANT INFORMATION

PARTICIPANT GENDER *
PARTICIPANT SPORT *

PARTICIPANT MEDICAL INFORMATION

PARENT/LEGAL GUARDIAN INFORMATION

EMERGENCY CONTACT INFORMATION

LIABILITY / WAIVER RELEASE AGREEMENT

By signing below, I agree to the medical and waiver release agreement. I the undersigned (if applicant/participant is 18 years of age or older) or parent/guardian of the above listed minor applicant/participant acknowledge that I have been advised of the risks involved in my son’s/daughter’s participation at the; Karidis Group International, Olympia Athletic Centre, Panathinaikos Athletic Club and have been made aware that his/her participation may result in injury or harm to my son/daughter and I assume responsibility for any and all such risk to my son/daughter. In the event that my son/daughter may sustain an injury as a result of their participation, I hereby agree to hold harmless; Karidis Group International, Olympia Athletic Centre, Panathinaikos Athletic Club, it’s directors, officers, coaches, athletic trainers, supervisors, and any other employees or agents there of including those who transport them to/from tryouts, practices, and games, for any and all such injuries. I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide my son/daughter with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I hereby authorize emergency transportation of my son/daughter to a medical treatment facility should an individual listed previously deem warranted. I affirmatively certify that to the best of my knowledge, my son/daughter is in good mental and physical health and capable of participating in this activity. I have read and fully understand the contents of this “hold harmless” agreement and execute same voluntary. If requested by; Karidis Group International, Olympia Athletic Centre, Panathinaikos Athletic Club staff, I agree to modify his/her activities as directed. I further give my permission for the free use of the participants name and image/video in broadcast, telecast, or any other media account of any and all event/activities and for the promotional purposes of the Karidis Group International, Olympia Athletic Centre, Panathinaikos Athletic Club. I also understand that my personal information will not be sold to any outside party and will only be used for contact and or marketing for the following; Karidis Group International, Olympia Athletic Centre, Panathinaikos Athletic Club. 

I, THE UNDERSIGNED BELOW; UNDERSTAND & AGREE TO THE ABOVE LIABILITY / RELEASE FORM. *
PARENT / LEGAL GUARDIAN SIGNATURE *
clear
 +
Secured by Formsite