Boston Fencing Club Release of Liability Waiver and Emergency Contact Form

Fencer Details:

Fencer First name

Fencer Last name

Fencer/Guardian Email

Phone

Fencer date of birth

Describe any special needs you/your child may have and/or physical limitations:

Emergency Contact Details:

Emergency Contact Name

Contact Phone Number

Optional Contact Name

Contact Phone Number

In the event of an emergency, permission is granted for the administration of emergency first aid by the Boston Fencing Club staff and, in the case of a serious accident when the emergency contacts are not available, permission is granted to arrange to take the fencer directly to an appropriate hospital. Check the box on the left.

I understand that participation in any sport carries a serious risk of injury, paralysis, or death and choose to participate in this sport and use the facility at my own risk and release the Boston Fencing Club, its coaches, instructors, officers and sponsors from any liability. I also recognize and understand that in the event of an injury occurring that I entered the premises accepting that possibility. Neither shall I hold other fencers liable for the routine risk of fencing.

Fencer or Guardian Signature

I understand while I am or my child is participating in any Activity, I, or my child, may be photographed or videotaped. I agree to allow my photo, video, film, or other such likeness to be used for any legitimate purpose by the Boston Fencing Club

Yes

Child's school/school district

If 'other' above, please explain; Or if 'word of mouth', let us know who referred you

Boston Fencing Club Release of Liability Waiver and Emergency Contact Form

Fencer Details:

Emergency Contact Details:

Boston Fencing Club

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