PEAK  PERFORMANCE 

SPORT  TAEKWONDO  CAMP

October 9-10, 2010

WAIVER & RELEASE OF LIABILITY, ASSUMPTION OF RISK, AND PARENTAL CONSENT & INDEMNITY AGREEMENT

In consideration of the enrollment of myself or my minor child, on behalf of myself or the minor child and on behalf of my and the minor child’s heirs, executors, representatives, assigns and administrators, I do hereby forever waive, release, discharge, and covenant not to sue Juan Moreno, ADVANCED TAEKWONDO SYSTEMS (hereinafter collectively, “ATS”),  its successors and assigns, NORTHEAST SPORTS TRAINING AND REHABILITATION, LLC and NORTHEAST SPORTS TRAINING, INC., their successors & assigns (hereinafter collectively, “NESTR”) its and their agents, coaches, representatives, volunteers, owners, officers, members, directors, instructors, sponsors and the lessor of the premises at which this event  takes place, from any and all demands, costs, damages, actions, causes of action or suits of any kind or nature, whether for personal injury, property damage or otherwise, that are in any way related to my or my minor child’s participation in any ATS or NESTR activity. 

I further agree, on behalf of myself and the minor child and on behalf of the minor child’s heirs, executors, representatives, assigns and administrators, to indemnify and hold harmless Juan Moreno, Peak Performance , ATS and NESTR its and their agents, coaches, representatives, volunteers, owners, officers, members, directors, instructors, sponsors and the lessor of the premises at which any Peak Performance, ATS or NESTR activity takes place, from any and all liability arising from any and all claims  (including for the negligence of any of them that may result in personal injury, accident, illness or death), demands, costs, attorneys fees, damages, actions, causes of action or suits of any kind or nature that are in any way related to my or my minor child’s participation in this activity.

I fully understand the nature of Olympic-style Taekwondo sparring activities, full-contact sparring and the physical conditioning program required for such activities.  Furthermore, I believe that my experience and capabilities, or those of my minor child, are sufficient to participate in the training programs provided by Juan Moreno, ATS and NESTR.  I understand that Taekwondo sparring activities along with the physical conditioning program required for such activities involve risks and dangers of serious bodily injury, including permanent disability, head injury, paralysis and death.  These risks and dangers may be caused by myself or the minor child’s own actions or inactions or by others participating in the activity.  I acknowledge that I have assumed these risks. 

In the event I am or my minor child is injured in any ATS or NESTR activity, I hereby authorize ATS and NESTR to provide medical treatment or assistance by licensed medical professionals or athletic trainers.  On behalf of myself or the minor child and on behalf of my and the minor child’s heirs, executors, representatives, assigns and administrators, I do hereby forever waive, release, discharge, and covenant not to sue ATS and NESTR its and their agents, coaches, representatives, volunteers, owners, officers, members, directors, instructors, sponsors and the lessor of the premises at which medical treatment or assistance is provided, for any medical treatment or assistance provided.  I further agree, on behalf of myself or the minor child and on behalf of my and the minor child’s heirs, executors, representatives, assigns and administrators, to indemnify and hold harmless ATS and NESTR its and their agents, coaches, representatives, volunteers, owners, officers, members, directors, instructors, sponsors  and the lessor of the premises at which medical treatment or assistance is provided from any and all liability arising from any and all claims (including for the negligence of any of them that may result in personal injury, accident, illness or death), demands, costs, damages, actions, causes of action or suits of any kind or nature that are in any way related to the provision of any medical treatment or assistance.  I further agree to pay for any and all financial obligations incurred as a result of any such medical treatment or assistance.

I have read this Agreement, fully understand its terms and understand that I or my minor child have given up substantial rights.  I further acknowledge that Juan Moreno, ATS and NESTR have relied on my execution of this Agreement as an inducement to enroll me or my minor child in this Taekwondo Program. I represent and warrant to Juan Moreno, ATS and NESTR that I have signed this Agreement freely and without any inducement, coercion or assurance of any nature and that I intend it to be a complete and unconditional release of all liability and indemnification to the fullest extent allowed by the law.  I fully acknowledge that if any portion of this Agreement is held to be invalid, the remaining portions shall continue in full force and effect.

___________________________      ___________________________      ____________

Participant’s Printed Name                Participant’s Signature*                     Date

__________________________        ___________________________      _____________

Parent/Guardian’s Printed Name       Parent/Guardian’s Signature              Date

*I certify that I am over the age of 18 if this Agreement is not also signed by my Parent or Guardian.

PEAK  PERFORMANCE 

SPORT  TAEKWONDO  CAMP

October 9-10, 2010

Visual Media Release

I hereby give Juan Moreno, Tom Chea, Advanced Taekwondo Systems and Northeast Sport Training & Rehabilitation the absolute and irrevocable right and permission, with respect to the photographs, videotapes and/or any other visual media that have been taken of me (or which include me along with others) at this event:

1. To use, re-use, publish and re-publish the same in whole or in part, individually or in conjunction with other photographs or images, in any medium whatsoever, including but not limited to illustrations, promotions, and advertising.

2. To use my name in connection therewith if so chosen.

I hereby release and discharge Juan Moreno, Tom Chea, Advanced Taekwondo Systems and Northeast Sport Training and Rehabilitation from any and all claims and demands arising out of, or in connection with the use of the photographs, video, and/or any other visual media including all claims for libel.

I am over eighteen (18) years of age. I have read the foregoing and fully understand the contents thereof.

Name of Athlete ________________________________________________

Name of parent (if minor) __________________________________________

Signature______________________________________________________

Date ___________________________________________________

AWARD  CEREMONY  AND  RECEPTION

Sunday     October 10, 2010

5:00 – 10:00 pm

After the completion of training on Sunday, there will be an Award Ceremony and Reception for all participating coaches, athletes and families. The event will be hosted by Coach Juan Moreno.    

Food and refreshments will be served. 

Be sure to join us for this exciting conclusion to the 3rd Annual Peak Performance Camp.  Registered athletes attend at no cost. 

There will be a $20 charge for each additional (non-athlete) guest . 

Please indicate if you will attend by circling the appropriate response below. 

Will you attend the Award Ceremony & Reception?      YES    or    NO

Name of Athlete:  _______________________________________

Number of additional  guests:   _____________________________

Total Additional Charge ($20/person  X  # guests) :  _____________

Check or Money Order for the reception should be made payable to

ADVANCED TAEKWONDO SYSTEMS  and attach to this form.  Thank you.