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Sports Ability Games Athlete Application - Swimming Classic

Date: Sunday, May 16, 2021
Location: Gulliver Preparatory School - Upper School Campus Pool

Athlete Information
First Name
Middle Initial/Name
Last Name
Suffix
Country
Address Line 1
Address Line 2
City
State
Postal Code
/
/
Classifications
Intellectual Disabilities
Spinal Lesion
Visually Impaired
Cerebral Palsy
Les Autres Swimming
Amputee
Dwarf
Deaf

Coach/Chaperon
First Name
Middle Initial/Name
Last Name
Suffix
Parent Information
First Name
Middle Initial/Name
Last Name
Suffix

Swimming Events

Important Documents
By checking the box below you are stating that you agree with the terms stated in the "Mandatory Release Form"
IN CONSIDERATION of accepting this entry, we the parent(s), guardian(s), and contestant, 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, including Gulliver Schools, 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 (including Covid-19 related illnesses), injuries, loss of life, or damage to persons or property that may arise directly or indirectly from or be in any way connected to contestant’s participation in or practice for any Junior Orange Bowl event, including contestant’s travel to or from event venue. We the parent(s) and/or guardians and contestant, hereby grant full consent to the Junior Orange Bowl, for the free use of contestant’s photograph or name in any broadcast, telecast, publication or other account of any of the Junior Orange Bowl practices, events and travel, for any purpose whatsoever.
MEDICAL VERIFICATION AND CONSENT
We parent and / or guardian, attest that the applicant is physically able and has sufficiently trained for the competition and that contestant’s physical condition has been verified by a licensed medical doctor, and we consent to any medical treatment for contestant.
CONSENT FOR MEDIA REPRODUCTION
We, parent and / or guardian and contestant, hereby grant full consent to the Junior Orange Bowl Committee, Inc., for the free use of contestant’s picture or name in any broadcast, telecast or other account of any Junior Orange Bowl festival practices, events and travel for any purpose whatsoever. Please

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