Xtreme Athletics Parental Consent / Child Participation Waiver

(Please Fill out the form below)

Important-All participants must have a valid USATF Member Number. To retrieve or apply for your number click here.

Xtreme Athletics Parental Consent / Child Participation Waiver

We the parents or legal guardian of the applicant do hereby grant permission for our child to attend Xtreme Athletics. We understand that while our child is at Xtreme Athletics, he or she will be trained by Xtreme Athletics, Doug Lytle (Xtreme Athletics’ Owner), and/or Xtreme Athletics staff and employees to safely and correctly engage in the act of pole vaulting. We understand that, as part of this process, our child might engage in the act of pole vaulting. We understand that pole vaulting is a potentially dangerous activity and hereby waive and release any and all rights and claims for damages due to injury or death that may be suffered before, during, and after Xtreme Athletics. We understand that the use of protective equipment such as helmets, pads, or other such devices, may help to reduce the risk of injury, but will not prevent it. WE HEREBYSTATE THAT XTREME ATHLETICS IS NOT RESPONSIBLE FOR ANY DAMAGES ARISING FROM PERSONAL INJURIES SUSTAINED BY OUR CHILD AS A RESULT OF OUR CHILD’S USE OF THE FACILITIES AND/OR EQUIPMENT OF XTREME ATHLETICS, DOUG LYTLE’S XTREME ATHLETICS, AND/OR ANY OF XTREME ATHLETICS STAFF OR EMPLOYEES. WE AGREE TO RELEASE AND DISCHARGE XTREME ATHLETICS, DOUG LYLTE’S XTREME ATHLETICS, AND/OR XTREME ATHLETICS’ STAFF OR EMPLOYEES, FROM ANY AND ALL CLAIMS, DEMANDS, DAMAGES, RIGHTS OF ACTION, OR CAUSES OF ACTION, PRESENT OR FUTURE, WHETHER THE SAME BE KNOWN OR UNKNOWN, ANTICIPATED OR UNANTICIPATED, RESULTING FROM OR ARISING OUT OF OUR CHILD’S USE OR INTENDED USE OF THE FACILITIES AND/OR EQUIPMENT OF XTREME ATHLETICS, DOUG LYTLE, OR XTREME ATHLETIC’S STAFF OR EMPLOYEES. WARNING: Sports, by their very nature, pose the continuous threat of injury that n type of equipment can ensure against or prevent. Any person not willing to assume the risk of injury inherent in sports activities should not and may not participate in Xtreme Athletics. We certify that our child has registered with the United States of America Track and Field (USATF.org) as a member prior to arriving at camp, and will provide our child with proof of membership to present to Xtreme Athletics’ staff and/or employees at check in. We hereby grant permission for Xtreme Athletics to use any photographic depictions, video depictions, or other forms of media captured of my child participating in camp activities for educational, advertising, or other purposes. In the event of a medical emergency, should we be unable to be contacted we hereby authorize Xtreme Athletics, Doug Lytle, and/or Xtreme Athletics’ staff and employees, to seek out and provide the services of any certified physician, nurse, or trainer selected by Xtreme Athletics, Doug Lytle, and/or Xtreme Athletics’ staff and employees WE AGREE THAT XTREME ATHLETICS’ DOUG LYTLE, AND/OR XTREME ATHLETICS’ STAFF AND EMPLOYEES ARE NOT LIABLE FOR ANY INJURY AND/OR DAMAGE RESULTING FROM, OR ARISING OUT OF, THE CARE PROVIDED BY THE AFOREMENTIONED HEALTH PROFESSIONALS. WE FURTHER AGREE TO RELEASE AND DISCHARGE XTREME ATHLETICS, DOUG LYTLE, AND/OR XTREME ATHLETICS’ STAFF OR EMPLOYEES FROM ANY CLAIM RESULTING FROM, OR ARISING OUT OF, THE AFOREMENTIONED CARE. BY OUR SIGNATURE, WE, THE UNDERSIGNED, ATTEST, AFFIRM, CERTIFY, AND DECLARE THAT WE HAVE READ AND UNDERSTAND THIS WAIVER IN ITS ENTIREITY.

Athlete Agreement

I ________________ (athlete’s name) hereby state to agree to and abide by all Xtreme Athletics rules listed below. I understand that failure to follow these rules can result in temporary suspension or complete removal of my membership to Xtreme Athletics. I understand that the degree of membership status following a rule violation will be discussed and upheld by the Xtreme Athletics coaches along with the owner of the gym. I understand that failure to follow these rules will cause the coaches and owner to contact my parents to discuss the violation of rules in detail and to determine the future standing of my membership at Xtreme Athletics Rules: 1. Be kind and courteous to coaches, other vaulters, and parents/ spectators 2. I MUST obtain and hold a current USATF membership in order to vault at Xtreme Athletics 3. Treat equipment with respect (as if it were my own) 4. Return pole vault equipment to its original place 5. Be mindful of your surroundings (this is a gym with lots of moving bodies and pieces of equipment) 6. Clean up after yourself 7. Be respectful of other people’s personal space 8. Come with a positive attitude and willingness to learn 9. Ask if you don’t know what to do or where something belongs 10. Return weights and weight equipment to their respective storage area 11. Always lift with a spotter 12. Xtreme Athletics has a zero-tolerance policy for drugs and alcohol 13. Have fun and enjoy the privilege of pole vaulting

Athlete's Name

First Name

Last Name

Athlete's Signature

By typing your name in the box below you are electronically signing this document.

First Name

Last Name

Guardian/Parent's Name

First Name

Last Name

Guardian/Parent's Signature

By typing your name in the box below, you are electronically signing this document.

First Name

Last Name

Athlete's Cell Phone

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Parent's Cell Phone

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Email Address

Athlete's USATF Number

All participants are required to be a USATF member!

COVID -19 Waiver

As an Addendum to the Parent/ Guardian Consent form as well as the athlete form, you as a member/ parent or guardian of a member agree and understand the following: By entering this facility, you are aware that you agree to fully accept all known and unknown risks, including the potential risk of exposure to respiratory illnesses such as the coronavirus (COVID-19). The coronavirus is primarily transmitted via exhaled respiratory droplets, most often through coughing and sneezing. These droplets can travel up to six feet and are more commonly transmitted between persons rather than from equipment to persons. Although we regularly sanitize our equipment and presently are using enhanced cleaning methods and enforcing social distancing in our facility, you understand that you may be exposed to the coronavirus or its symptoms through no fault of our own. Known coronavirus symptoms include fever, coughing, shortness of breath, pneumonia, kidney failure, and may include other symptoms, stroke or even death (collectively "Symptoms"). You understand and agree that you will hold us harmless and you will not hold us liable for any real or perceived Symptoms of COVID-19 or any other disease, illness, or condition, nor for exacerbating any existing symptoms, and you fully agree to accept all risks of entering the facility, using the equipment, working with personal trainers, attending classes, and/or interacting or being exposed to other members.