Georgia Tech Cheerleading Recruitment Interest

Name *

First

Last

Email *

Grade

Age

Phone

Current High School / Program

Current GPA

Current Stunt Position / Skill Level

Current Tumbling Skill Level

Admissions Status

Emergency Contact *

First

Last

Emergency Contact Phone Number

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

In consideration of being allowed to participate in the Georgia Tech Athletic Association promotional activity knows as Coach Shana’s Skills Camps & Clinics, I hereby agree as follows: I for myself and my estate, heirs, administrators, executors, and assigns, hereby release and hold harmless Shana Belden, 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 indemnify and hold harmless the Releasees from any judgment, settlement, loss, liability, damage, or costs, including court costs and attorney fees for both the trial and appellate levels that Releasees may incur as a proximate result of any negligent or deliberate act or omission on my part during my participation in the activity, to the fullest extent permitted by law. 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 Shana Belden, or the nearest Georgia Tech official. Lastly, I grant Shana Belden, and the Georgia Tech Athletic Association (hereinafter referred to as the “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).

Coach Shana’s Cheerleading Skills Camps & Clinics

I am 18 or older
I am a minor and have parental consent

E-Signature