PARENTAL CONSENT FORM

Required for all participants under the age of 18

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Participant Contact Information

Name: ____________________

Date of Birth: ______________         Graduation Year: __________

Email Address: _______________

School: _____________________

Home Address: ______________________________

City: _______________  State: __________  Zip: __________

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PARENT/GUARDIAN INFORMATION (Emergency Contact):

Name: _______________      Relationship: _______________

Email Address: ____________________       Phone: _______________

Address (If different from above): ______________________________

 

In consideration for the admission of this junior participant in any activity at the Ozark Dynamics Training Facility, I hereby:

1. Give my permission for this Junior’s participation.

2. Release Ozark Dynamics, LLC and ACE Tomato Company, LLC and any other organization sponsoring or supporting such activity (including all directors, officers, employees, agents, and volunteer workers) from any claim or liability that may arise directly or indirectly from this Junior’s presence or participation in the activity.

3. Agree to defend, indemnify, and hold harmless the parties referred to in Item 2 above from any claim arising from any wrongful or negligent conduct by the Junior.

4. Agree that photographs of the participant taken during any events conducted at the Ozark Dynamics Training Facility and the competition results (if any) may be published or reproduced by Ozark Dynamics, LLC in its printed or electronic communications.

 

Junior Participant Signature: _______________________________

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Parent/Guardian Signature: ________________________________