EMPIRE ATHLETICS WAIVER/RELEASE FORM
For good and valuable consideration, the receipt and sufficiency of which are hereby
acknowledged, I, [name as appears below], as parent or legal
guardian of [child as appears below], minor (hereinafter
“minor”) hereby grant the permission necessary to allow Minor to participate in the class
conducted by “Empire Athletics LLC.” I acknowledge and agree, in my own behalf and on the
behalf of the Minor, acknowledge that the Minor is assuming the risk of such illness or injury by
participating in the classes. In the event of such illness or injury, I authorize “Empire Athletics
LLC.” to obtain necessary medical treatment for the Minor. I further acknowledge and
understand that I will be responsible for any and all medical and related costs that may be
incurred on behalf of the Minor for illness of injury that the Minor may sustain during the classes
and while traveling to and from the class site.
I, in my own behalf and on behalf of the Minor, further agree to release and hold harmless
Releasees for any and all liability for negligence or any other claim, judgment, loss, liability, cost
and expenses (including, without limitations, attorney’s fees and costs) arising out of or
connected with the “Empire Athletics LLC.” classes, including traveling to and from the classes. I
further expressly agree to indemnify and hold harmless Releasees and Releasees heirs,
successors, assigns, executors and administrators against loss from any further claims, demands
or actions that may subsequently be brought by Minor or by any other person or persons on
account of damages of any character resulting to the Minor in any way from the forgoing
activities. I further agree to reimburse and to make good to Releasees any loss, damages or costs
Releasees may have to pay as a result of any such action, claim or demand.
By signing this document, I acknowledge that if anyone is hurt or property is damaged during the
Minor’s participation in the facilities activities, that the Parent holds full responsibility for the
Minors actions in the event that the Minor may be found by a court of law to maintain a lawsuit
against “Empire Athletics LLC.”, it’s owners and instructors on the basis of the Minor’s claim
from which I have released the Minor herein.
I, in my own behalf and on behalf of the Minor, hereby warrant that I have read this Release and
Waiver in its entirety and fully understand its contents. I, in my own behalf and on the behalf of
the Minor, am aware that this Release and Waiver releases from liability and contains an
acknowledgment of my voluntary and knowing assumption of the risk of injury or illness. I, in my
own behalf and behalf of the Minor have signed the document voluntarily and of my own free will.
I, in my own behalf and behalf of the Minor have read this completely and understand the terms,
and agree to be bound by its terms.
I grant Empire Athletics LLC., its subsidiaries, affiliates, licensees, successors, assignees,
management and employees the right to use my child’s name, voice, musical, renditions, and my
likeness, image and picture of my child for any lawful purpose whatsoever, regardless of whether
or not I am ever employed by or remain employed by Empire Athletics LLC. I waive my right to
inspect and/or approve the finished product or the advertising copy. I also release, discharge, and
agree to save and hold Empire Athletics LLC., and it subsidiaries, affiliates, licensees, successors,
assignees and management and employees harmless from any liability by reason of blurring,
distortions, alterations, optical illusions or use in composite form, whether intentional or
otherwise, that may occur or be produced in the taking of the pictures or recording or in the
processing or completion of the finished product. All work performed or products produced by me
or my child are the property of Empire Athletics LLC., and its affiliates.