General Use and Waiver/Release Form

Name of Participant *
Name of Participant
Name of Legal Guardian
Name of Legal Guardian
What brings you out? *
Phone *
IN CONSIDERATION OF ___________________________________, (Name of Minor Child/Ward) my child/ward, being allowed to participate in any way in rccreational, social or fitness related programming at the Play To Win Athletic Center (Facility) located at 44600 Guilford Drive, #100, Ashburn, VA 20147, the undersigned acknowledges, appreciates, and agrees that: The risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, 1) FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE PARTICIPANTS, spectators, instructors, others, and assume full responsibility for my child’s participation; and 2). If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and, 3) I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY, RELEASE AND HOLD HARMLESS The Play To Win Athletic Center and Play To Win, LLC; its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event, WITH RESPECT TO ANY AND ALL LIABILITIES INCIDENTS, INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my, or my child’s/ward’s involvement or participation in programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.