Cheer & Goldrush Appearance Request Form

Name of Event *

Company Name / Organization *

Contact Name *

First

Last

Contact Email *

Contact Cell Phone Number *

Event Date *

Start Time *

Please indicate the time you would like GT Cheer and Goldrush to appear at your event (not your overall start time). Our student-athletes will arrive 15 minutes before this start time.

End Time *

Please indicate the time you would like GT Cheer and Goldrush to leave your event (not your overall end time).

Event Type *

Number of Cheer / Dance Team Members Requested *

Parking Information *

Event Address *

Address Line 1

Address Line 2

City

State

Zip Code

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

WAIVER OF LIABILITY, EXPRESS ASSUMPTION OF RISKS, HOLD HARMLESS & PHOTO RELEASE AGREEMENT

In consideration of being permitted to participate in the Georgia Tech Athletic Association promotional activity known as a Georgia Tech Cheerleading and Goldrush Dance Team Appearance, I hereby agree as follows: I for myself and my estate, heirs, administrators, executors, and assigns, hereby release and hold harmless the Georgia Tech Athletic Association, Georgia Institute of Technology, the Board of Regents of the University System of Georgia, the Georgia Tech Athletic Association Board of Trustees, the State of Georgia and their respective officers, directors, employees, representatives, agents, and volunteers (collectively, the “Releasees”), from any and all liability and responsibility whatsoever, however caused, for any and all damages, claims, or causes of action that I, my estate, heirs, administrators, executors, or assigns may have for any loss, illness, personal injuries included, but not limited, to sprains, strains, contusions, concussions, fractures, knee injuries, neck injuries, back injuries, death, or property damage arising out of, connected with, or in any manner pertaining to the activity, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or others, and assume full responsibility for my participation. I fully understand that there are potential risks associated with my participation in the activity, including, but not limited to, possible injury or loss of life. Despite the potential hazards associated with the activity, I wish to proceed, and freely accept and assume all risks, dangers, and hazards that may arise from my participation in the activity and that could result in loss, illness, personal injury, death, or property damage to me or to my property. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others. I further agree to defend, indemnify, and hold harmless Releasees from and against any judgment (including by third parties), settlement, loss, liability, damage, or costs, including court costs and attorney fees for both the trial and appellate levels, that Releasees may incur in whole or in part, directly or indirectly, known or unknown, foreseen and unforeseen, resulting in any way whatsoever from all activities arising out of the Event, whether caused by the negligence of the Releasees, or while participating in such activity or while in or upon the premises where the activity is being conducted. In signing this agreement, I acknowledge and represent that I have read and understand it; that I sign it voluntarily and for full and adequate consideration, fully intending to be bound by the same; and that I am at least eighteen (18) years of age, and willingly agree to comply with the stated and customary terms and conditions for participation in the activity, or I am the legal guardian of the consenting minor participant. I will participate in a safe and reasonable manner and if I observe any unusually significant hazards during my presence or participation, I will remove myself from participation and bring such hazards to the immediate attention of the nearest Georgia Tech official. Lastly, I grant the Georgia Tech Athletic Association (“Association”) all rights to use my photograph(s) from the Event in perpetuity for any and all marketing the Association engages in, and any and all publications, videos, websites, or other printed or electronic materials produced by the Association or its agents for the Association’s use and benefit. I understand that, by granting the Association these rights, I waive any claim or action of any nature arising because of, or in connection with, the photograph(s) and/or use of my photographic image(s). I have read this release of liability form. I fully understand its terms and sign it freely and voluntarily without inducement.