AMERICAN TURNERS NORTHWEST CHICAGO
First Name________________________ Last Name ______________________________
Address__________________________ City __________________ Zip Code__________
Age__________ Birth Date_________________ Medical Conditions ________________
Mother’s Name_____________________ Phone Number _____________________________
Father’s Name _____________________ Phone Number_____________________________
E-Mail ____________________________ Turner Member?____________________________
How did you find out about us? ___________________________________________________
Name _____________________ Relationship _______________ Phone __________________
Class ______________________ Registration Date ___________________________________
RELEASE AND HOLD HARMLESS AGREEMENT
Parent of participants under the age of 18 should read this form carefully and be aware that in registering for and participating in this program, you will be waiving and releasing all claims for injuries or damages you might personally sustain arising from this program.
As a parent of a minor participating in this program, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries, damages, or loss which I may sustain as a result of my minor child’s participation in such programs as against the American Turners-Northwest Chicago, its officers, agents, servants, and employees.
I do hereby fully release and discharge the American Turners-Northwest Chicago and its officers, agents, servants, and employees from any and all claims from injuries, damage, or loss which I may have or which may accrue to me as a result of my minor child’s participation in this program.
I further agree to indemnify, hold harmless and defend the American Turners-Northwest Chicago and its officers, agents, servants, and employees from any and all claims resulting from injuries, damages, and losses sustained by me and arising out of, connected with, or in any way associated with the activities of the program (or with my minor child’s participation in the activities of the program).
I have read and fully understand this Release and Hold Harmless Agreement.
Signature _____________________________________ Date ______________________
Print Name ___________________________________