Basic Registration

Program Title *

Program Day and Time *

Childs Full Name *

Gender

Male

Female

Grade as of Sept. 2020

Date of Birth

School

Home Address

Zip Code

Home Telephone

Parent #1

Parent #1 Cell Phone

Parent #1 Bus Phone

Parent #1 Email *

Parent #2

Parent #2 Cell Phone

Parent #2 Bus Phone

Parent #2 Email

Emergency Contact (other than parents)

Emergency Contact Phone (other than parents)

List of Allergies or other special concerns

NOTES

Payment Amount $

Payment Options (check one)

VENMO - @simplysports

Visa

Master Card

American Express

Check payable to Simple Sports - 370 East 76th Street Suite B1403 - NY NY 10021

Use my Spring 2020 Credit

Credit Card #

Expiration Date

Name on Card

CVS Security Code

Billing Address (if different from the home address)

On-line form submission and signature *

By submitting this on-line form submission and the corresponding SUBMIT button, which constitutes my electronic signature, I ACKNOWLEDGE I HAVE READ AND I ACCEPT ALL ENROLLMENT CONDITIONS AND POLICIES AS SET FORTH ON WWW.SIMPLYSPORTS.NET, INCLUDING THE PERMISSION TO PARTICIPATE, PERMISSION FOR TRANSPORTATION, RELEASE FROM LIABILITY, COVENANT NOT TO SUE, CONSENT TO MEDICAL TREATMENT, AND PHOTO RELEASE AND FURTHER THAT I AM SIGNING FREELY AND VOLUNTARILY AND INTEND MY ELECTRONIC SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. I understand and agree that the foregoing Release and Waiver is intended to be as broad and inclusive as is permitted by the law of the State of New York and that if any portion there of is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. This authorization is valid for all Programs that occur on and after the date of electronic signature and continuing for a period of 365 calendar days, unless revoked in writing by one of the parties. By entering my electronic signature below, I affirm that I have read and agree to the term and conditiond to this regitration. (required)

I agree

I do not agree

Type signature, read Waiver and scroll to the bottom to submit this form. (required) *

Release and Waiver of Liability

Permission for Participation. By submitting this on-line form submission and the corresponding “SUBMIT” button, which constitutes my electronic signature, I permit my child to fully participate in the voluntary, recreational, athletic and extra-curricular activities sponsored by Simply Sports, Inc. (the “Program” or “Simply Sports”).

Permission for Transportation. By submitting this on-line form submission and the corresponding “SUBMIT” button, which constitutes my electronic signature, I permit my child to be transported to and from the Program in any manner, including transportation by a car or a passenger van driven by an employee or agent of Simply Sports.

Photo Release. By submitting this on-line form submission and the corresponding “SUBMIT” button, which constitutes my electronic signature, I consent to the use of photographs taken by Simply Sports, or its agents, of my children or me to be used for editorial or promotional uses in any media or electronic form and waive all rights which may arise as a result.

Simply Sports Policies. By submitting this on-line form submission and the corresponding “SUBMIT” button, which constitutes my electronic signature, I agree to the terms and conditions of Program’s policies as set forth on the website, including the refund policy.

Covenant Not To Sue: By submitting this on-line form submission and the corresponding “SUBMIT” button, which constitutes my electronic signature, I acknowledge that I am forever barred from suing Simply Sports, its officers and its employees, as a result of my child’s participation in the Program.

Assumption of Risks: Physical activity, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. Simply Sports uses facilities for and provides for activities such as running and sporting activities. Some of these involve strenuous exertions of strength using various muscle groups, some involve quick movements involving speed and change of direction, and others involve sustained physical activity, which places stress on the cardiovascular system. The specific risks vary from one activity to another, but the risks range from minor injuries such as scratches, bruises and sprains, to major injuries such as eye injury, joint or back injuries, concussions, heart attacks, paralysis and death. I have read the previous paragraphs and I know and understand and appreciate these and other risks that are inherent in the Program. I hereby assert that my child’s participation is voluntary and I knowingly assume all risks. I acknowledge that my child must strictly adhere to all rules and instructions during the Program. To the best of my knowledge, my child is in good health and has no disability or condition that renders his/her participation in the Program medically inadvisable, or otherwise limits his/her ability to participate

Consent to Medical Treatment. In an emergency, Simply Sports or its designees will attempt to reach me (my emergency contact) as soon as possible but I understand that should it not be possible to contact me, I authorize any health care provider selected by Simply Sports or its designee to provide medical care and treatment including, but not limited to x-ray examination, anesthetic, medical, dental or surgical diagnosis, or treatment and medical care which may be recommended and provided under the general supervision of any physician or surgeon, for Participant which, in their judgment, is necessary for the health and well-being of my child. I also permit Simply Sports or its designees to transport my child to the hospital or medical/dental office if needed

Release from Liability. In consideration of permission to use, today and on all future dates, the property, facilities, staff, equipment and services of Simply Sports and in consideration of my child’s participation i the Programs, I, for myself, my children, spouse, and agents, acknowledge that by submitting this on-line form submission and the corresponding “SUBMIT” button, which constitutes my electronic signature, release, waive and forever discharge Simply Sports, its directors, employees, volunteers, and agents, from liability from all claims, demands, damages and causes of action, pertaining to or arising out of my child’s participation in the Program, including but not limited to, claims for ordinary negligence resulting in personal injury, accidents, breach of contract, or breach of warranty arising from participation in the Program, observation and use of facilities or equipment and transportation to or from a Program.