Common use of PHOTOGRAPHY RELEASE Clause in Contracts

PHOTOGRAPHY RELEASE. I hereby agree to allow the Spooky Nook Sports to record and publish photos and videos (including audio) of myself for the purpose of promoting Spooky Nook Sports in a manner that does not violate NCAA Bylaw 12.5.2 and for documenting and/or reporting events and activities. I understand photographs, video and/or audio tape recordings to be taken of myself and/or family members at practice, during competition, recreational play, as well as other Spooky Nook Sports related events. I understand that this media will be produced and used for promotional purposes that do not violate NCAA Bylaw 12.5.2, and I authorize Spooky Nook Sports to use my/our photograph, video and/or audio recording on its Website and social media platforms, such as Facebook, Twitter, YouTube, FourSquare and Pinterest, etc., as well as other official printed publications without further consideration. In addition, I acknowledge Spooky Nook Sports’ right to crop or treat the media at its discretion, and I also acknowledge that Spooky Nook Sports may choose not to use my/our image at this time, but may do so as its own discretion at a later date. I also understand that once I, or my family members, image(s) have been captured, they may be posted on the Spooky Nook Sports Website or social media platforms, the image can be downloaded by any computer user on or off the premises of the Sports Complex. Spooky Nook Sports also reserves the right to discontinue use of photos without notice. I HAVE READ THIS RELEASE OF LIABILITY AND PHOTOGRAPY RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. / / PARTICIPANT’S NAME AGE BIRTHDATE PARENT/GUARDIAN NAME EMAIL ADDRESS ADDRESS PHONE NUMBER CITY STATE/ZIP SIGNATURE ORTHOPEDIC ASSOCIATES OF LANCASTER CONSENT FOR EMERGENCY ASSESSMENT AND TREATMENT BY ATHLETIC TRAINERS I consent to the performance of emergency services, including assessment and management of injuries at the Spooky Nook Sports Complex, as may be deemed necessary or advisable and in accordance with protocols established by physicians of Orthopedics Associates of Lancaster, Ltd. I understand that services are provided by licensed athletic trainers of Orthopedic Associates of Lancaster. I understand that the licensed athletic trainers may determine that I need to be referred to a physician or a hospital emergency department for further assessment and treatment of my injury. This consent for treatment is effective until revoked. Patient Date Patient's Legal Representative or Guardian Relationship to Patient FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINORITY AGE (Under age 18 at time of registration) This is to certify that I am the parent or guardian of the minor Participant named above, having legal responsibility for this minor, and I do hereby consent (with the approval of my spouse, if any) to the minor’s participation in the Activities at The Nook and agree to the Release of Liability as provided above and hereby make and enter into each and every representation, certification, waiver, release, assumption and indemnity described above in the Release of Liability on behalf of myself, the minor, any other parent or guardian of the minor, and our heirs, assigns, personal representatives, and next of kin. I agree to give up my rights, the minor’s rights, and the rights of any other parent or guardian to maintain any claim or suit against Releasees arising out of the minor's presence or participation in the Activities at The Nook. I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THESE WAIVERS AND RELEASES, and I agree to indemnify and defend the Releasees for all liability arising out of any lack of authority on my part to make such waivers and releases.

PHOTOGRAPHY RELEASE. I hereby agree to allow the Spooky Nook Sports VSC to record and publish photos and videos (including audio) of myself for the purpose of promoting Spooky Nook Sports in a manner that does not violate NCAA Bylaw 12.5.2 VSC and for documenting and/or reporting events and activities. I understand photographs, video and/or audio tape recordings to be taken of myself and/or and/ or family members at practice, during competition, recreational play, as well as other Spooky Nook Sports VSC related events. I understand that this media will be produced and used for promotional purposes that do not violate NCAA Bylaw 12.5.2purposes, and I authorize Spooky Nook Sports VSC to use my/our photograph, video and/or audio recording on its Website and social media platforms, such as Facebook, Twitter, YouTube, FourSquare and Pinterest, etc., as well as other official printed publications without further consideration. In addition, I acknowledge Spooky Nook Sports’ VSC’s right to crop or treat the media at its discretion, and I also acknowledge that Spooky Nook Sports VSC may choose not to use my/our image at this time, but may do so as its own discretion at a later date. I also understand that once I, or my family members, image(s) have been captured, they may be posted on the Spooky Nook Sports VSC Website or social media platforms, the image can be downloaded by any computer user on or off the premises of premises. Therefore, I agree to indemnify and hold harmless from any claims the Sports Complex. Spooky Nook Sports following: · VSC coaches and other team members · VSC employees VSC also reserves the right to discontinue use of photos without notice. I HAVE READ THIS RELEASE OF LIABILITY AND PHOTOGRAPY RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. / / PARTICIPANT’S NAME AGE / / BIRTHDATE PARENT/GUARDIAN NAME EMAIL ADDRESS ADDRESS PHONE NUMBER CITY STATE/STATE ZIP SIGNATURE ORTHOPEDIC ASSOCIATES OF LANCASTER CONSENT FOR EMERGENCY ASSESSMENT AND TREATMENT BY ATHLETIC TRAINERS I consent to the performance of emergency services, including assessment and management of injuries at the Spooky Nook Sports Complex, as may be deemed necessary or advisable and in accordance with protocols established by physicians of Orthopedics Associates of Lancaster, Ltd. I understand that services are provided by licensed athletic trainers of Orthopedic Associates of Lancaster. I understand that the licensed athletic trainers may determine that I need to be referred to a physician or a hospital emergency department for further assessment and treatment of my injury. This consent for treatment is effective until revoked. Patient Date Patient's Legal Representative or Guardian Relationship to Patient FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINORITY AGE (Under age 18 at time of registration) This is to certify that I am the parent or guardian of the minor Participant named above, having legal responsibility for this minor, and I do hereby consent (with the approval of my spouse, if any) to the minor’s participation in the Activities at The Nook associated with VSC and agree to the Release of Liability as provided above and hereby make and enter into each and every representation, certification, waiver, release, assumption and indemnity described above in the Release of Liability on behalf of myself, the minor, any other parent or guardian of the minor, and our heirs, assigns, personal representatives, and next of kin. I agree to give up my rights, the minor’s rights, and the rights of any other parent or guardian to maintain any claim or suit against Releasees arising out of the minor's ’s presence or participation in the Activities at The Nookassociated with VSC. I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THESE WAIVERS AND RELEASES, and I agree to indemnify and defend the Releasees for all liability arising out of any lack of authority on my part to make such waivers and releases.. PARENT/GUARDIAN SIGNATURE (Print name) Date signed RECONOCIMIENTO DE RIESGO, LIBERACIÓN DE RESPONSABILIDAD, ACUERDO DE INDEMNIZACIÓN Y PACTO DE NO DEMANDAR (“ACTIVIDADES ACUERDO DE PARTICIPACIÓN”) En consideración de que se les permita participar en cualquier formación, eventos y actividades (“Actividades”) asociados con los deportes de Victoria, LLC, Princeton Elite Management Group, LLC, a / k / a Victoria Deportes, Victory Sports, la victoria de la Fundación Deporte, Victoria Deportes Academia, Victory Sports Fútbol, Victory Sports Baloncesto (“VSC”) situado en XX Xxx 000 Xxxxxxxxx, XX 00000, yo, , el abajo firmante, reconoce, aprecia y acepta que:

PHOTOGRAPHY RELEASE. I hereby agree to allow the Spooky Nook Sports to record and publish photos and videos (including audio) of myself for the purpose of promoting Spooky Nook Sports in a manner that does not violate NCAA Bylaw 12.5.2 and for documenting and/or reporting events and activities. I understand photographs, video and/or audio tape recordings to be taken of myself and/or family members at practice, during competition, recreational play, as well as other Spooky Nook Sports related events. I understand that this media will be produced and used for promotional purposes that do not violate NCAA Bylaw 12.5.2purposes, and I authorize Spooky Nook Sports to use my/our photograph, video and/or audio recording on its Website and social media platforms, such as Facebook, Twitter, YouTube, FourSquare and Pinterest, etc., as July 30, 2013 well as other official printed publications without further consideration. In addition, I acknowledge Spooky Nook Sports’ right to crop or treat the media at its discretion, and I also acknowledge that Spooky Nook Sports may choose not to use my/our image at this time, but may do so as its own discretion at a later date. I also understand that once I, or my family members, image(s) have been captured, they may be posted on the Spooky Nook Sports Website or social media platforms, the image can be downloaded by any computer user on or off the premises of the Sports Complex. Therefore, I agree to indemnify and hold harmless from any claims the following: • Spooky Nook Sports coaches and other team members • Spooky Nook Sports employees Spooky Nook Sports also reserves the right to discontinue use of photos without notice. I HAVE READ THIS RELEASE OF LIABILITY AND PHOTOGRAPY RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. / / PARTICIPANT’S NAME AGE BIRTHDATE PARENT/GUARDIAN NAME EMAIL ADDRESS ADDRESS PHONE NUMBER CITY STATE/ZIP SIGNATURE ORTHOPEDIC ASSOCIATES OF LANCASTER CONSENT FOR EMERGENCY ASSESSMENT AND TREATMENT BY ATHLETIC TRAINERS I consent to the performance of emergency services, including assessment and management of injuries at the Spooky Nook Sports Complex, as may be deemed necessary or advisable and in accordance with protocols established by physicians of Orthopedics Associates of Lancaster, Ltd. I understand that services are provided by licensed athletic trainers of Orthopedic Associates of Lancaster. I understand that the licensed athletic trainers may determine that I need to be referred to a physician or a hospital emergency department for further assessment and treatment of my injury. This consent for treatment is effective until revoked. Patient Date Patient's Legal Representative or Guardian Relationship to Patient FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINORITY AGE (Under age 18 at time of registration) This is to certify that I am the parent or guardian of the minor Participant named above, having legal responsibility for this minor, and I do hereby consent (with the approval of my spouse, if any) to the minor’s participation in the Activities at The Nook and agree to the Release of Liability as provided above and hereby make and enter into each and every representation, certification, waiver, release, assumption and indemnity described above in the Release of Liability on behalf of myself, the minor, any other parent or guardian of the minor, and our heirs, assigns, personal representatives, and next of kin. I agree to give up my rights, the minor’s rights, and the rights of any other parent or guardian to maintain any claim or suit against Releasees arising out of the minor's presence or participation in the Activities at The Nook. I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THESE WAIVERS AND RELEASES, and I agree to indemnify and defend the Releasees for all liability arising out of any lack of authority on my part to make such waivers and releases.

PHOTOGRAPHY RELEASE. I hereby agree to allow the Spooky Nook Sports to record and publish photos and videos (including audio) of myself for the purpose of promoting Spooky Nook Sports in a manner that does not violate NCAA Bylaw 12.5.2 and for documenting and/or reporting events and activities. I understand photographs, video and/or audio tape recordings to be taken of myself and/or family members at practice, during competition, recreational play, as well as other Spooky Nook Sports related events. I understand that this media will be produced and used for promotional purposes that do not violate NCAA Bylaw 12.5.2purposes, and I authorize Spooky Nook Sports to use my/our photograph, video and/or audio recording on its Website and social media platforms, such as Facebook, Twitter, YouTube, FourSquare and Pinterest, etc., as July 30, 2013 well as other official printed publications without further consideration. In addition, I acknowledge Spooky Nook Sports’ right to crop or treat the media at its discretion, and I also acknowledge that Spooky Nook Sports may choose not to use my/our image at this time, but may do so as its own discretion at a later date. I also understand that once I, or my family members, image(s) have been captured, they may be posted on the Spooky Nook Sports Website or social media platforms, the image can be downloaded by any computer user on or off the premises of the Sports Complex. Therefore, I agree to indemnify and hold harmless from any claims the following:  Spooky Nook Sports coaches and other team members  Spooky Nook Sports employees Spooky Nook Sports also reserves the right to discontinue use of photos without notice. I HAVE READ THIS RELEASE OF LIABILITY AND PHOTOGRAPY RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. / / PARTICIPANT’S NAME AGE BIRTHDATE PARENT/GUARDIAN NAME EMAIL ADDRESS ADDRESS PHONE NUMBER CITY STATE/ZIP SIGNATURE ORTHOPEDIC ASSOCIATES OF LANCASTER CONSENT FOR EMERGENCY ASSESSMENT AND TREATMENT BY ATHLETIC TRAINERS I consent to the performance of emergency services, including assessment and management of injuries at the Spooky Nook Sports Complex, as may be deemed necessary or advisable and in accordance with protocols established by physicians of Orthopedics Associates of Lancaster, Ltd. I understand that services are provided by licensed athletic trainers of Orthopedic Associates of Lancaster. I understand that the licensed athletic trainers may determine that I need to be referred to a physician or a hospital emergency department for further assessment and treatment of my injury. This consent for treatment is effective until revoked. Patient Date Patient's Legal Representative or Guardian Relationship to Patient FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINORITY AGE (Under age 18 at time of registration) This is to certify that I am the parent or guardian of the minor Participant named above, having legal responsibility for this minor, and I do hereby consent (with the approval of my spouse, if any) to the minor’s participation in the Activities at The Nook and agree to the Release of Liability as provided above and hereby make and enter into each and every representation, certification, waiver, release, assumption and indemnity described above in the Release of Liability on behalf of myself, the minor, any other parent or guardian of the minor, and our heirs, assigns, personal representatives, and next of kin. I agree to give up my rights, the minor’s rights, and the rights of any other parent or guardian to maintain any claim or suit against Releasees arising out of the minor's presence or participation in the Activities at The Nook. I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THESE WAIVERS AND RELEASES, and I agree to indemnify and defend the Releasees for all liability arising out of any lack of authority on my part to make such waivers and releases.

PHOTOGRAPHY RELEASE. I hereby agree to allow the Spooky Nook Sports Central Pennsylvania Krunch, Inc. to record and publish photos and videos (including audio) of myself for the purpose of promoting Spooky Nook Sports Central Pennsylvania Krunch, Inc. in a manner that does not violate NCAA Bylaw 12.5.2 Bylaws and for documenting and/or reporting events and activities. I understand photographs, video and/or audio tape recordings to be taken of myself and/or family members at practice, during competition, recreational play, as well as other Spooky Nook Sports Central Pennsylvania Krunch, Inc. related events. I understand that this media will be produced and used for promotional purposes that do not violate NCAA Bylaw 12.5.2Bylaws, and I authorize Spooky Nook Sports Central Pennsylvania Krunch, Inc. to use my/our photograph, video and/or audio recording on its Website and any social media platformsplatforms utilized by Central Pennsylvania Krunch, Inc., such as Facebook, Twitter, YouTube, FourSquare and Pinterest, Instagram, etc., as well as other official printed publications without further consideration. In addition, I acknowledge Spooky Nook Sports’ Central Pennsylvania Krunch, Inc. has the right to crop or treat the media at its discretion, and I also acknowledge that Spooky Nook Sports Central Pennsylvania Krunch, Inc. may choose not to use my/our image at this time, but may do so as its own discretion at a later date. I also understand that once I, or my family members, image(s) have been captured, they may be posted on the Spooky Nook Sports Central Pennsylvania Krunch, Inc. Website or social media platforms, the image can be downloaded by any computer user on or off the premises of the Sports Complexuser. Spooky Nook Sports Central Pennsylvania Krunch, Inc. also reserves the right to discontinue use of photos without notice. I HAVE READ THIS RELEASE OF LIABILITY AND PHOTOGRAPY RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. / / PARTICIPANT’S NAME AGE BIRTHDATE PARENT/GUARDIAN NAME EMAIL ADDRESS ADDRESS PHONE NUMBER CITY STATE/ZIP SIGNATURE ORTHOPEDIC ASSOCIATES OF LANCASTER CONSENT FOR EMERGENCY ASSESSMENT AND TREATMENT BY ATHLETIC TRAINERS I consent to the performance of emergency services, including assessment and management of injuries at the Spooky Nook Sports Complex, medical treatment or procedures as may be deemed necessary or advisable appropriate in emergency circumstances, including treatment by physicians, hospital and/or clinic personnel, and in accordance with protocols established by physicians of Orthopedics Associates of Lancaster, Ltd. I understand that services are provided by licensed athletic trainers of Orthopedic Associates of Lancaster. I understand that the licensed athletic trainers may determine that I need to be referred to a physician or a hospital emergency department for further assessment and treatment of my injuryother appropriate health care providers. This consent for emergency treatment is effective until revoked. Patient Date Patient's Legal Representative or Guardian Relationship to Patient Emergency Contact Name and Number Physician Name and Number Allergies/Reactions Limitations FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINORITY AGE (Under age 18 at time of registration) This is to certify that I am the parent or guardian of the minor Participant named above, having legal responsibility for this minor, and I do hereby consent (with the approval of my spouse, if any) to the minor’s participation in the Activities at The Nook of Central Pennsylvania Krunch, Inc. and agree to the Release of Liability as provided above and hereby make and enter into each and every representation, certification, waiver, release, assumption and indemnity described above in the Release of Liability on behalf of myself, the minor, any other parent or guardian of the minor, and our heirs, assigns, personal representatives, and next of kin. I agree to give up my rights, the minor’s rights, and the rights of any other parent or guardian to maintain any claim or suit against Releasees arising out of the minor's presence or participation in the Activities at The Nook. of Central Pennsylvania Krunch, Inc.. I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THESE WAIVERS AND RELEASES, and I agree to indemnify and defend the Releasees for all liability arising out of any lack of authority on my part to make such waivers and releases.

PHOTOGRAPHY RELEASE. I hereby agree to allow the Spooky Nook Sports to record and publish photos and videos (including audio) of myself for the purpose of promoting Spooky Nook Sports in a manner that does not violate NCAA Bylaw 12.5.2 and for documenting and/or reporting events and activities. I understand photographs, video and/or audio tape recordings to be taken of myself and/or family members at practice, during competition, recreational play, as well as other Spooky Nook Sports related events. I understand that this media will be produced and used for promotional purposes that do not violate NCAA Bylaw 12.5.2purposes, and I authorize Spooky Nook Sports to use my/our photograph, video and/or audio recording on its Website and social media platforms, such as Facebook, Twitter, YouTube, FourSquare and Pinterest, etc., as 3623473.1 well as other official printed publications without further consideration. In addition, I acknowledge Spooky Nook Sports’ right to crop or treat the media at its discretion, and I also acknowledge that Spooky Nook Sports may choose not to use my/our image at this time, but may do so as its own discretion at a later date. I also understand that once I, or my family members, image(s) have been captured, they may be posted on the Spooky Nook Sports Website or social media platforms, the image can be downloaded by any computer user on or off the premises of the Sports Complex. Therefore, I agree to indemnify and hold harmless from any claims the following: • Spooky Nook Sports coaches and other team members • Spooky Nook Sports employees Spooky Nook Sports also reserves the right to discontinue use of photos without notice. I HAVE READ THIS RELEASE OF LIABILITY AND PHOTOGRAPY RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. / / PARTICIPANT’S NAME AGE BIRTHDATE PARENT/GUARDIAN NAME EMAIL ADDRESS ADDRESS PHONE NUMBER CITY STATE/ZIP SIGNATURE ORTHOPEDIC ASSOCIATES OF LANCASTER CONSENT FOR EMERGENCY ASSESSMENT AND TREATMENT BY ATHLETIC TRAINERS I consent to the performance of emergency services, including assessment and management of injuries at the Spooky Nook Sports Complex, as may be deemed necessary or advisable and in accordance with protocols established by physicians of Orthopedics Associates of Lancaster, Ltd. I understand that services are provided by licensed athletic trainers of Orthopedic Associates of Lancaster. I understand that the licensed athletic trainers may determine that I need to be referred to a physician or a hospital emergency department for further assessment and treatment of my injury. This consent for treatment is effective until revoked. Patient Date Patient's Legal Representative or Guardian Relationship to Patient FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINORITY AGE (Under age 18 at time of registration) This is to certify that I am the parent or guardian of the minor Participant named above, having legal responsibility for this minor, and I do hereby consent (with the approval of my spouse, if any) to the minor’s participation in the Activities at The Nook and agree to the Release of Liability as provided above and hereby make and enter into each and every representation, certification, waiver, release, assumption and indemnity described above in the Release of Liability on behalf of myself, the minor, any other parent or guardian of the minor, and our heirs, assigns, personal representatives, and next of kin. I agree to give up my rights, the minor’s rights, and the rights of any other parent or guardian to maintain any claim or suit against Releasees arising out of the minor's presence or participation in the Activities at The Nook. I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THESE WAIVERS AND RELEASES, and I agree to indemnify and defend the Releasees for all liability arising out of any lack of authority on my part to make such waivers and releases.

PHOTOGRAPHY RELEASE. I hereby agree to allow the Spooky Nook Sports to record and publish photos and videos (including audio) of myself for the purpose of promoting Spooky Nook Sports in a manner that does not violate NCAA Bylaw 12.5.2 and for documenting and/or reporting events and activities. I understand photographs, video and/or audio tape recordings to be taken of myself and/or family members at practice, during competition, recreational play, as well as other Spooky Nook Sports related events. I understand that this media will be produced and used for promotional purposes that do not violate NCAA Bylaw 12.5.2purposes, and I authorize Spooky Nook Sports to use my/our photograph, video and/or audio recording on its Website and social media platforms, such as Facebook, Twitter, YouTube, FourSquare and Pinterest, etc., as well as other official printed publications without further consideration. In addition, I acknowledge Spooky Nook Sports’ right to crop or treat the media at its discretion, and I also acknowledge that Spooky Nook Sports may choose not to use my/our image at this time, but may do so as its own discretion at a later date. I also understand that once I, or my family members, image(s) have been captured, they may be posted on the Spooky Nook Sports Website or social media platforms, the image can be downloaded by any computer user on or off the premises of the Sports Complex. Therefore, I agree to indemnify and hold harmless from any claims the following: Spooky Nook Sports coaches and other team members Spooky Nook Sports employees Spooky Nook Sports also reserves the right to discontinue use of photos without notice. I HAVE READ THIS RELEASE OF LIABILITY AND PHOTOGRAPY RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. / / ___________________________________________ _______ _______/_______/___________ PARTICIPANT’S NAME AGE BIRTHDATE ___________________________________________ __________________________________________________________ PARENT/GUARDIAN NAME EMAIL ADDRESS ___________________________________________________________ ___________________________________________ ADDRESS PHONE NUMBER ______________________________ _____________________ ___________________________________________ CITY STATE/ZIP SIGNATURE ORTHOPEDIC ASSOCIATES OF LANCASTER CONSENT FOR EMERGENCY ASSESSMENT AND TREATMENT BY ATHLETIC TRAINERS I consent to the performance of emergency services, including assessment and management of injuries at the Spooky Nook Sports Complex, as may be deemed necessary or advisable and in accordance with protocols established by physicians of Orthopedics Associates of Lancaster, Ltd. I understand that services are provided by licensed athletic trainers of Orthopedic Associates of Lancaster. I understand that the licensed athletic trainers may determine that I need to be referred to a physician or a hospital emergency department for further assessment and treatment of my injury. This consent for treatment is effective until revoked. _____________________________ _______________________________ Patient Date ________________________________ _______________________________ Patient's Legal Representative or Guardian Relationship to Patient FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINORITY AGE (Under age 18 at time of registration) This is to certify that I am the parent or guardian of the minor Participant named above, having legal responsibility for this minor, and I do hereby consent (with the approval of my spouse, if any) to the minor’s participation in the Activities at The Nook and agree to the Release of Liability as provided above and hereby make and enter into each and every representation, certification, waiver, release, assumption and indemnity described above in the Release of Liability on behalf of myself, the minor, any other parent or guardian of the minor, and our heirs, assigns, personal representatives, and next of kin. I agree to give up my rights, the minor’s rights, and the rights of any other parent or guardian to maintain any claim or suit against Releasees arising out of the minor's presence or participation in the Activities at The Nook. I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THESE WAIVERS AND RELEASES, and I agree to indemnify and defend the Releasees for all liability arising out of any lack of authority on my part to make such waivers and releases.. _____________________________ __________________________ _______________