New Client Paperwork

1Basic Information

2Availability

3Questionnaire

4Outside Waiver

5Liability

6Media Release

7Emergency Contact

Have you scheduled your tour?*
- Yes, I’ve already scheduled a tour!
- No, I need to schedule a tour.
Great! What date did you and our admin team schedule your tour for?*
MM slash DD slash YYYY
*A tour date is required prior to completing paperwork. Please give us a call at 702-485-5515 to set up your tour today!
Child's Full Name*
Child's Date of Birth*
Month
Day
Year
Gender*
Do you have a 2nd child?*
- Yes
- No
Child's Full Name*
Child's Date of Birth*
Month
Day
Year
Gender*
Do you have a 3rd child?*
- Yes
- No
Child's Full Name*
Child's Date of Birth*
Month
Day
Year
Gender*
Primary Guardian 1: We will contact you first
Guardian First Name*
Guardian Last Name*
Guardian Email*
Home
Cell
Work
Address
City
State
Zip
Relation to Child?*
Best Cell Phone to send text reminders
Parent/Guardian 2
Guardian 2 First Name
Guardian 2 Last Name
Guardian 2 Email
Home
Cell
Work
Relation to Child?
Funding?
Funding Type?
Case Manager Name
Case Manager Phone Number
Case Manager Email
How did you hear about Sport-Social?
How did you hear about us?*
Please let us know who we can thank

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Assumption of Risk and Release of Liability
Name of Primary Participant*
Date of Birth*
Month
Day
Year
Phone Number
Immediate Family Members (here for tour)*
WE ARE AWARE THAT SPORT-SOCIAL’S ACTIVITIES ARE POTENTIALLY DANGEROUS AND HAZARDOUS ACTIVITIES AND THAT THE PARTICIPANT COULD BE SERIOUSLY INJURED OR EVEN KILLED BY PARTICIPATING IN THESE ACTIVITIES. THE PARTICIPANT IS VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH GUARDIAN’S PERMISSION AND KNOWLEDGE OF THE DANGER INVOLVED, AND, GUARDIAN, ON BEHALF OF PARTICIPANT, AGREES TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH, AND/OR PROPERTY DAMAGE, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN. WE ARE FURTHER AWARE THAT CERTAIN RISKS ARE INHERENT IN THE PARTICIPATION IN SPORT-SOCIAL’S ACTIVITIES, INCLUDING, BUT NOT LIMITED TO, FRACTURED, BROKEN AND/OR SPRAINED WRISTS, ANKLES, FINGERS, ARMS, AND LEGS.
Consent*
I certify that I have read and understand the above risks for all participants.
The undersigned Guardian does hereby release, forever discharge and agree to hold harmless Sport-Social, its officers, employees, volunteers and agents (“Releases”), from and against any and all liability, claims, demands, lawsuits, and expenses (including medical) that the Participant or myself, or any of our assignees, heirs, or representatives, now have or may have in the future, from any personal injury, sickness, death, or property damage of any nature whatsoever which may be incurred or suffered by the Participant or I, arising out of or in any way connected, directly or indirectly to: (a) the Participant’s participation in Sport-Social’s activities, including, but not limited to, skateboarding, biking, skating or the use of a scooter; (b) the negligent, willful or intentional acts, however caused, by any Release; (c) the condition of the premises where Participant is engaging in the activities; or (d) the equipment used during such activities. The undersigned further acknowledges and understands that helmets are required at all times while participating in Sport-Social’s activities and shall be furnished at the sole expense of the Participant and/or Guardian. Further, Sport-Social strongly recommends the use of additional safety equipment including, but not limited to, elbow pads, knee pads and wrist guards.

Furthermore, the undersigned gives permission to Sport-Social and its officers, directors, owners, employees, volunteers, and agents, to furnish any and all necessary transportation for the Participant. The undersigned Guardian certifies that he/she is the parent or legal guardian of the Participant, and shall be responsible for any and all actions of the Participant.
Name of Guardian*
Signature of Guardian*
Date*
MM slash DD slash YYYY
Name of Other Participant
Signature of Other Participant
Date
MM slash DD slash YYYY

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Media Release
I do hereby grant permission to Sport-Social, their affiliates, subsidiaries, photographers, employees and their respective agents and licensees (collectively, the “Parties”) to use my family’s name, image, likeness and voice, worldwide and perpetuity, as memorialized in any form of media in conjunction with materials generated by or commissioned by Sport-Social, including, without limitation, use in connection with the promotion or exhibition of footage or still photography for Sport-Social’s business purposes (“Release”).

I hereby irrevocably relinquish, give and assign to Sport-Social, all right, title and interest that I may have in the finished pictures, film, video and/or audio tape, negatives, reproductions, copies of the original prints, footage and negatives, derivative works, advertising, or other copies that may be used in connection therewith (“Materials”) and further, grant to Sport-Social the right to give, sell, transfer, broadcast, license and exhibit such finished Materials that may be used in connection to any business, firm, publication or to any of their assignees without restriction. I hereby waive any right that I may have to inspect or approve the finished Materials or the advertising or other copy that may be used in connection therewith or the use to which it may be applied.

I release and agree to hold harmless the Sport-Social Parties and those acting under their respective permission or authorization, from any liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking, reproduction and/or display of the Materials, unless it can be shown that such production and/or publication thereof were maliciously caused. I waive any claim to any compensation of any kind through the sale, license, transfer or any use of the Materials and, further, release and agree to hold the Sport-Social Parties harmless from any claim or cause of action for defamation, invasion of rights of privacy or publicity or otherwise based upon or relating to this Release or the use and exploitation of the Materials.

I release and agree to hold harmless the Sport-Social Parties and those acting under their respective permission or authorization, from any liability for actions of the general public or owners/promoters of the event and Sport-Social in no way bears responsibility for their use of my family’s name, image, likeness and voice, generated by their organization, without limitation, or use in connection with the promotion or exhibition of footage or still photographs for their business purposes.

I warrant that I have read the above Release prior to signing it and I am fully familiar with the contents of this Release.
Consent*
- I Agree
- I Disagree
Name*
Signature*
Date*
MM slash DD slash YYYY

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New Client Paperwork

*A tour date is required prior to completing paperwork. Please give us a call at 702-485-5515 to set up your tour today!

Primary Guardian 1: We will contact you first

Parent/Guardian 2

Funding?

How did you hear about Sport-Social?

Availability

Questionnaire

Outside Waiver

Assumption of Risk and Release of Liability

Media Release

Student Emergency Contact Form

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