Waiver Form About youPlease enter your email address* Enter Email Confirm Email E-mail address of the person filling out the form, usually parent or guardian. A copy of this waiver will be emailed to you. Please enter a phone numberAbout the ParticipantName* First Last Please enter the First and Last name of the Participant. One form is required for each participant. Date of Birth* Please enter the date of birth of the participant. Kong Academy Program*Community Events (Sundays)Birthday PartyWalk-In / Other EventsGoogle Corporate Recess ProgramFall 2019 BF DayFall 2019 Boys and Girls ClubFall 2019 BrooksideFall 2019 Eastside MontessoriFall 2019 GiddensFall 2019 GreenwoodFall 2019 John HayFall 2019 JSISFall 2019 MagnoliaFall 2019 McGilvraFall 2019 MeridianFall 2019 QAEFall 2019 UCDSFall 2019 Villa AcademyPlease select the relative Kong Academy Program. A list of current Programs per season and per School is provided. Who's the birthday kid?Emergency Contact InformationEmergency Contact (Full Name)*Please enter the Full Name of a good Emergency Contact for this participant. Emergency Contact (phone number)Please enter a good phone number for the Emergency Contact for this participant. The fine-printBy filling out this form, you are consenting to using this form as an electronic signature in lieu of an original signature on paper. Signature* I, the undersigned, voluntarily request to participate in parkour indoor/outdoor classes with Kong Academy (hereinafter “Events”)Parkour* I understand and agree to the below. 1. Parkour needs to be practiced with the utmost caution at all times. Parkour is physically demanding and involves: running, climbing, jumping, vaulting, and other demanding full body activities which can involve height, speed, and erratic surfaces. Parkour is a high-impact activity which requires concentration and the practitioner's awareness of their body and environment. Associated Risks* I understand and agree to the below. 2. I recognize and accept that taking part in the Event(s) may involve a risk of bodily injury, partial and/or total disability and loss of life. Injuries may occur not only from my own actions, inactions, or negligence, but also from the actions, inactions, or negligence of others, the condition of the equipment, facilities, or areas where the Event(s) is performed, and/or the physically demanding nature of parkour. I, and/or my Parent or Guardian, assume full responsibility for my safety and actions at all times, including the actual participation of the Event(s), and/or at the Event(s) site, and/or on my own time. I, and/or my Parent or Guardian, accept responsibility for all potential risks and dangers associated with my participation in the Event(s). Safety* I understand and agree to the below. 3. I understand that I am responsible for my safety. I must practice good judgment at all times. If at any time I feel I cannot participate safely for any reason, either due to a physical circumstance, my own actions or of others, or any other reason, I must immediately stop participation and notify the staff. The same applies if I feel lightheaded, faint, weak, or in pain. As with any vigorous physical activity, I am conscious that I must take all necessary precautions, including but not limited to a consultation from my physician, prior to taking part in the Event(s). Health and Insurance* I understand and agree to the below. 4. I validate that I am in good health. I have no physical ailments that would prevent taking part in the Event(s) or put me at increased risk for injury. I acknowledge that all activities attempted at the Event(s) are done so at my own risk. Furthermore, I agree to use my personal medical insurance as a the sole medical coverage payment if an accident or injury occurs. I consent to emergency medical treatment if such care is required or recommended. Completely understanding all the risks involved with participation of this Event(s).Liability* I understand and agree to the below. 5. I hereby waive all claims or causes of action against KONG ACADEMY LLC, its employees, volunteers, administrators, directors, officers, agents, and other participants, along with any sponsors, advertisers, and if applicable, owners and/or lessors of the premises on which the Event(s) takes place (collectively and hereinafter “Releases”). I agree to indemnify and hold harmless Released from all claims, liability, demands, damages, or losses on my account, even if caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise, and agree that if, despite this release, waiver of liability, and assumptions of risk I, or anyone on my behalf, makes a claim against any of the Releasees, I will indemnify, save and hold harmless each of the Releasees from any loss, liability, damage, litigation expense, attorney fees or costs they may incur as the result of such a claim.Media (Optional) I understand and agree to the below. 6. I understand that KONG ACADEMY LLC occasionally takes photos and video of classes and events for use in newsletters, websites, YouTube Channel, Facebook, and other social media. KONG ACADEMY LLC will NEVER identify any individuals by name when publishing promotional material. KONG ACADEMY LLC will ALWAYS seek explicit permission to include names of students, and for any project that would include selling or licensing any student’s likeness. Consent* I understand and agree to the below. 7. I HAVE READ THIS WAIVER AND RELEASE OF LIABILITY, ASSUMPTION OF RISK AND HOLD HARMLESS AGREEMENT. I FULLY COMPREHEND ITS PROVISIONS, AND I AGREE TO GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HAVE SIGNED THIS AGREEMENT VOLUNTARILY WITHOUT ANY PROVOCATION OR ASSURANCES, AND INTEND MY SIGNATURE BE ONE THAT COMPLETES AND UNCONDITIONALLY RELEASES ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. Minors* I understand and agree to the below. 8. IF THE PARTICIPANT IS UNDER THE AGE OF 18: I HEREBY CERTIFY THAT I AM THE LEGAL GUARDIAN / PARENT OF THE PARTICIPANT, AND I HAVE DISCUSSED THE RISKS OUTLINED IN THIS DOCUMENT TO MY CHILD, AND EXPLAINED OUR MUTUAL RESPONSIBILITIES AS OUTLINED ABOVE. FURTHERMORE, I ACKNOWLEDGE THAT SIGNING BELOW DESIGNATES MY AGREEMENT TO ALL OF THE CONDITIONS STATED IN THIS DOCUMENT. Newsletter* Yes, Opt me in No, Opt me out As a participant to our programs, you will receive program-related communications. Would you also like to join our mailing list to receive monthly news - upcoming events and classes? This iframe contains the logic required to handle Ajax powered Gravity Forms.