RELEASE OF LIABILITY, AND MEDICAL AUTHORIZATION Please enable JavaScript in your browser to complete this form. – Step 1 of 2Name *FirstLastEmail *Address *Address Line 1City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNextAre you 18 or older? *NoYesKnown Allergies/Medical Conditions/MedicationsGuardian Name *FirstLastGuardian Email *Guardian Phone *Release of Liability *I agree to the following:WAIVER AND RELEASE OF LIABILITY I, the undersigned parent or legal guardian of the above-named participant, hereby acknowledge and agree as follows: Assumption of Risk: I fully understand that participation in any sports or physical training activity, including those organized by Fútskills Academy, involves risks of injury, including but not limited to sprains, strains, fractures, concussions, or other serious injury. I voluntarily assume all such risks. Release of Liability: In consideration of my child’s participation, I hereby fully release and discharge, and agree to indemnify and hold harmless: ◦ Fútskills Academy ◦ Rosalia LoChirco and or Fernando Errecalde ◦ and any coaches, trainers, directors, employees, volunteers, or affiliates thereof, from any and all claims, liabilities, damages, or costs, including attorneys’ fees, arising out of or relating to any injury, loss, or damage that may occur during or in connection with participation in Fútskills Academy programs or events, regardless of whether caused by negligence. Medical Authorization: I authorize Fútskills Academy staff and representatives to seek and obtain necessary medical treatment for my child in case of injury or emergency, and I accept full financial responsibility for any such treatment. Photo/Media Release: I grant permission for images or video of my child taken during training or events to be used for promotional or marketing purposes by Fútskills Academy. Binding Agreement: This waiver shall be binding upon me and my child, our heirs, successors, and assigns. I acknowledge that I have read, understood, and voluntarily agreed to the above terms. Date *Submit