EmailMe Form - REVO 495 ELITE FOOTBALL TRAINING

Player Age *

Player Information

Player Name *

First Last

What town are you from? *

Carpooling *

Yes, I want to participate in carpooling back and forth to training.

No we do not want to participate in carpooling.

Player Email *

What are your goals? *

Position(s) *

Address *

Street Address City State / Province / Region Postal / Zip Code

Player Cell Phone *

### - ### - ####

Date of Birth *

MM / DD / YYYY

Height *

Weight *

Name of Current School *

What team(s) do you currently play for? *

Graduation Year *

HUDL

Twitter

Instagram

Upload a Headshot *

NO HELMET

Parent/Guardian Information

Guardian Name *

First Last

Guardian Email *

Guardian Cell Phone *

### - ### - ####

Medical

Each participant is required to be covered by medical insurance.

Insured Name *

First Last

Relationship to player *

Insurance Company Carrier & Plan or Group Number *

Insurance ID Number *

Allergies *

Medication *

Dietary Restrictions *

As a participant with Long Island Elite Football and Revolution Athletics ("Organizations"), I acknowledge that participation with the Organizations exposes me to a possible risk of personal injury. I, hereby release L I Elite, Inc and Revolution Athletics (“Companies”) and its officers, directors, employees, agents, licensees, subsidiaries, consultants, independent contractors and affiliates, from any and all liability from property damage, personal injuries or other claims arising from or in connection with my participation in the Event including claims that are known and unknown, foreseen and unforeseen, future or contingent.

I covenant that I will not now or at any time in the future, directly or indirectly, commence or prosecute any action, suit or other proceeding against Long Island Elite Football, L I Elite, Inc,, Revolution Athletics, and its officers, directors, employees, agents, licensees, subsidiaries, consultants, independent contractors and affiliates, arising out of or relating to the actions, causes of action, claims and demands hereby waived, released or discharged by me.

For good and adequate consideration, which I acknowledge I have received, I hereby grant, release, and quitclaim to the Company the right and authority to use, sell, reproduce, and distribute, quoted material, email address, biographical information, my photograph, likeness, recorded voice or videotaped filmed appearances obtained in connection with the Organization (the "Materials") for promotional and advertising purposes or programs as Company in its sole discretion will deem appropriate.

I acknowledge that I have read and fully understand this Player Authorization, Injury Waiver, and General Release Form. This agreement will be binding on me, my spouse, my children, legal representatives, heirs, successors and assigns.

DATE *

MM / DD / YYYY

Player Signature *

Clear

The undersigned ("Parent"), parent of ("Player"), hereby consent to affirm, and, on behalf of Player, agree to be bound by the Injury Waiver and General Release Form attached hereto which has been signed by Player. Parents also represent, warrant and agree that Parents (is)(are) entitled to the care and custody of Player and (is)(are) Player's legal guardian(s); that during the minority of Player and for a reasonable time afterwards, Parents will use all reasonable efforts to prevent Player from attempting to or actually disaffirming the Injury Waiver and General Release Form signed by Player; that Parents hereby acknowledge that Parents have read the Injury Waiver and General Release Form and are satisfied that it is fair and equitable for the benefit of Player; and that Parents will not revoke this consent and approval.

DATE *

MM / DD / YYYY

Parent Signature *

Clear

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