Waiver

"*" indicates required fields

Participant Name*

First Last

Program/Team Name*

Date Of Birth*

Age*

Parent/Guardian Name*

First Last

Email*

Phone*

Alternate Phone

Address

Street Address City State ZIP Code

Emergency Contacts*

Name

Phone

Doctor*

Phone*

Insurance Company*

Policy Number*

Please list any previous injuries, physical conditions or weaknesses that may affect the athlete Condition/Injury*

Medical Authorization and Liability Release*

I authorize COA Elite and its representatives to consent to medical treatment for myself/child when I cannot be reached to consent. I am fully aware that any activity involving motion, height or athletic activities create the possibility of serious injury, paralysis or even death. I further agree to hold COA Elite and its staff harmless for any injury or resulting expense(s). I release and discharge all rights and claims against COA Elite, and its parties. COA Elite strives to provide the maximum in safety procedures and guidelines, and cannot assume responsibility for any accidents, injuries or illness that may occur.

I agree to the Medical Authorization and Liability Release

Participant Consent*

The athlete listed above has permission to participate in COA Elite programs and/or camp. In consideration for the training and coaching provided by COA Elite and its staff, I understand that I must abide by the rules and regulations set forth by the coaches and staff. I understand that violations of any of these rules may result in removal from the classes and or events. We acknowledge and recognize that hazards are present in any athletic event and that injury may result. COA Elite coaches, staff and volunteers will not be liable for injury that occurs during cheer/dance practice, Rising Star Recreational classes, COA Elite camps, or Open Gym.

I agree to the Participant Consent Agreement

Signature*

If participant is under 18 years of age, parent must sign on behalf of the child.