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Athlete Registration Form

First Name

Last Name

Phone

Address

Birthday

Height

Weight

Coach and/or Team

Social Media Handle

READ BEFORE SIGNING In consideration of being allowed to participate in any way in an ON-X Naturals Sanctioned Event, related events and activities, the undersigned acknowledges, appreciates, and agrees that: The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF THE pwners Todd Rogers, Michael A. Gaytan, Promoter Adrianne Martin and ON-X Naturals or others, and assume full responsibility for my participation; and, these risks and dangers may be caused by my own actions or inaction’s, the actions or inactions of others participating in the activity, the condition in which the activity takes place, or the negligence of the “releases” named below; I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, There may be other risk and social and economic losses either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs, and damages I incur as a result of my participation or that of the minor in the activity. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS ON-X Naturals/ON-X Entertainment LLC, and their officers, officials, agents, and Todd Rogers/Michael A. Gaytan/Adrianne Martin, or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event Diva Spring Break WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, TO THE FULLEST EXTENT PERMITTED BY LAW. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Furthermore: For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby consent to the photographing of myself and the recording of my voice and the use of these photographs and/or recordings singularly or in conjunction with other photographs and/or recordings for advertising, publicity, commercial or other business purposes. I understand that the term "photograph" as used herein encompasses both still photographs and motion picture footage. I further consent to the reproduction and/or authorization by ON-X Entertainment, LLC/ON-X Naturals, Todd Rogers, Michael A. Gaytan, Adrianne Martin and media assigned to Diva Sst. Louis to reproduce and use said photographs and recordings of my voice, for use in all domestic and foreign markets. Further, I understand that others, with or without the consent of ON-X Entertainment, LLC/ON-X Naturals may use and/or reproduce such photographs and recordings. I hereby release ON-X Entertainment, LLC/ON-X Naturals, and any of its associated or affiliated Todd Rogers/Michael A. Gaytan, Adrianne Martin, companies, their directors, officers, agents, employees and customers, and appointed advertising agencies, their directors, officers, agents and employees from all claims of every kind on account of such use. I take full responsibility of my actions in respect to rules and regulations governed by ON-X Naturals, the hotel in which I have registered to stay while participating in Diva St. Louis and all rules of the Venue.

Your Signature

Today's Date

The following is for Teens Only and Parent/Guardian information is required at the time of the registration.
If this section does not apply to you, please hit register* at the bottom)

TEENS ONLY:

Parent/Guardian Signatue *Required*

Today's Date

Parent/Guardian Name *Required*

Relationship to Teen Competitor *Required

Emergency Phone Number *Required*

Acerca de

Athlete Registration Form

The following is for Teens Only and Parent/Guardian information is required at the time of the registration. *If this section does not apply to you, please hit *register* at the bottom)

TEENS ONLY:

The following is for Teens Only and Parent/Guardian information is required at the time of the registration.
If this section does not apply to you, please hit register* at the bottom)