Parent Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Youth Name *

First Name

Last Name

Phone *

(###)

###

####

Birth Date *

MM

DD

YYYY

Courage To Climb Competitive Boxing Liability Release / Hold Harmless Waiver *

In consideration for being allowed to participate in Courage To Climb program I am acting in my own capacity and on behalf of myself, my heirs, and my estate, do hereby release, Courage To Climb, coaches and volunteers, and all other entities and individuals of and from liability for injuries or damages which my child may suffer while participating in any part of Courage To Climb Program. I also agree to hold harmless the same individuals and entities outlined above from any liability or claims, for any damages or injuries my child may cause to a person or property of others while participating in Courage To Climb Program. I make this Release of Liability/ Hold Harmless Waiver voluntarily and with full knowledge of the hazards and inherent risks associated with Courage To Climb Program. I hereby expressly assume the risk of injury and property damage/loss.

Yes

No

Medical Release *

In the event that it becomes necessary, I grant permission for my child to be administered basic first aide by Courage To Climb coaches and/or volunteers. If further treatment is needed and I cannot be reached in an emergency, I hereby grant my permission to the physician or dentist available to hospitalize, to secure proper treatment, and/or order an injection, anesthesia, or surgery as deemed necessary. Additionally, I understand that my insurance carrier will be billed for all medical charges in the case of illness or injury while my son/daughter is at a Courage To Climb related activity. I understand that every activity sponsored by Courage To Climb/Championship Greatness Fitness Collective is carefully planned and adequately supervised by adults. However, even with the best of planning and precaution, unforeseen events can occur. By signing this form, as parent/guardian, I agree to assume and accept all risks and hazards inherent in Courage To Climb activities. I also agree not to hold Courage To Climb/Championship Greatness Fitness Collective, its coaches, or volunteers liable for damages, losses, or injuries to the person or property undersigned. As parent/guardian, I understand that I am signing for the minor named on this form and the signature is to provide medical and liability release.

Yes

No