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Wind Reach Archery
David Semos
Contact: David Semos
Email:
Telephone: 334-9349 /

Archery - SIGN-UP

Name: ______Parent/Guardian: ______

Year & Class: ______Age ______

Phone: (H) ______(W) ______Cell: ______

Email: ______

Date of Birth (D-M-Y) ______Right or Left handed ______

Height ______

MTN Sports Services

The Bermuda Blades Fencing Club

Archery – David Semos

WAIVER OF LIABILITY (your signature is required)

MTN Sports Services recognize that Fencing and Archery, like any sport, carries risk of injury. Therefore, in the event of an accident involving you/your child, we ask that you sign the following waiver attesting to your understanding of the risks involved and allowing The Bermuda Blades Fencing Club or Archery – David Semos to obtain medical care in the case of injury when no parent or guardian is present.

This form will be valid for the 2011 Fencing and Archery session January 1st to December 31st. 2012

Please indicate which sport you are signing up for.

Name of Fencer or Archer______

(Please Print)

ASSUMPTION OF RISKS: Fencing and or Archery is a physical activity which, by its very nature, carries with it certain inherent risk that cannot be eliminated regardless of the care taken to avoid injuries

Archery and or Fencing Classes include activities that can involve strenuous exertions of strength using various muscle groups, quick movements involving speed and change of direction, and sustained physical activity which can place stress on the cardiovascular system. The specific risks vary from one activity to another, but the risks range from minor injuries such as scratches, bruises, and sprains to major injuries such as eye injury, joint or back injuries, heart attacks and concussions.

WAIVER OF LIABILITY: In consideration of me or my child’s participation in the sponsored activities of MTN Sport Services, I acknowledge, agree to and understand that: I am fully aware of and appreciate the risks, including the risk of serious injury, paralysis or death, associated with my child’s participation in a Fencing and or Archery class. I further agree on behalf of myself, my heirs, and personal representatives, that MTN Sport Services, along with its coaches, volunteers, agents, and lessee of the premises, shall not be liable for any injury, loss of life or other loss or damage occurring as a result of me or my child’s participation in the club’s events, or as a result of equipment that may have been provided to me for those activities.

Fencer’s or Archer’s Signature ______Date ___/___/_____

Signature (of Parent or Legal Guardian) ______Date ___/___/_____

Consent for Medical Treatment: This is to certify that I, ______give my consent to MTN Sport Services and its representatives to obtain medical care from any licensed physician, hospital or clinic for the above named athlete for any injury or illness that may arise during activities associated with Fencing and Archery classes conducted by MTN Sport Services.

Signature of Parent or Legal Guardian) ______Date ___/___/_____