Name *

First Name

Last Name

Phone *

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I have read and understand the terms and conditions below, and affirm that I am the authorized parent/guardian for the participant identified above.

MANDATORY RELEASE FORM: In consideration of accepting this entry, we the parent(s), guardian(s), and participant, jointly and severally, and intending to legally bind ourselves, our heirs, executors and administrators, do knowingly and voluntarily waive, release, exonerate, discharge and agree to defend (a) the Junior Orange Bowl Committee, Inc., (b) the Cities and Counties of event venues, (c) the owners and operators of any public or private sports, recreation or other facility used for Junior Orange Bowl events, (d) all Junior Orange Bowl festival sponsors,(e) all Junior Orange Bowl members, staff and volunteers, (f) the individual coaches, instructors, supervisors, or supervising or coordinating organizations and (g) all members, agents, employees, representatives, successors and assigns of any of the foregoing, from any and all liability and/or claims for illness, injuries, loss of life, or damage to persons or property that may arise directly or indirectly from or be in any way connected to the player’s participation in or practice for any Junior Orange Bowl event, including participant’s travel to or from event venues. MEDICAL VERIFICATION AND CONSENT: We, the parent(s), guardian(s) and participant attest that the player is physically able and has sufficiently trained for the competition and that participant’s physical condition has been verified by a licensed medical doctor, and we consent to the provision of any needed medical treatment for the participant at our expense without further written or verbal authorization. CONSENT FOR MEDIA PRODUCTIONS: We parent(s) and/or guardian(s) and participant, hereby grant full consent to the Junior Orange Bowl for the free use of participant’s picture or name in any broadcast, telecast or other account of any of the Junior Orange Bowl practices, events and travel, for any purpose whatsoever.

Yes