Camper Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Phone # *

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Sessions *

Session 1: 7/1 - 7/4 (Somers)

Session 2: 7/8 - 7/11 (Yorktown: Sports Barn Field)

Session 3: 7/15 - 7/18 (Somers)

Session 4: 7/22 - 7/25 (Somers)

Session 5: 7/29 - 8/1 (Somers)

New! East Coast Sports Facility: 7/29 - 8/2

New! East Coast Sports Facility: 8/26 - 8/30

Participation Waiver *

Please read the following waiver Heart and Hustle Camp Liability Waiver Participation Waiver, Release and Assumption of Risk. I have volunteered my child to participate in Heart and Hustle Sports and Agility Camp provided to me by Heart and Hustle Sports LLC, which may include, but may not be limited to, aerobic or cardiovascular exercise, skills training of a variety of sports, and speed/agility training. In consideration of Heart and Hustle Sports’ agreement to instruct and teach my child I do here now and forever release and discharge and hereby hold harmless Heart and Hustle and its employees/volunteers from any and all claims demands, damages rights of action or causes of action, present or future, arising out if or connected with my participation in this or any exercise program including any injuries resulting there from. THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF (1) Equipment belonging to Heart and Hustle Sports or to myself that may malfunction or break, (2) any slip, fall, dropping of equipment (3) and/or negligent instruction or supervision. I have been informed of, understand and am aware that any exercise training and sports program, whether or not requiring use of exercise/sports equipment, is a potentially hazardous activity. l also have been informed of, understand and am aware that any exercise and/or sports activities involve a risk of injury, as well as abnormal changes in blood pressure, fainting, and a remote risk of heart attack, stroke, other serious disability or death, and that I am voluntarily participating my child in these activities and using equipment and machinery with full knowledge, understanding and appreciation of the dangers involved. I hereby agree to expressly assume and accept any and all risks of injury, regardless of severity, or death. I have been advised that an examination by a physician should be obtained by anyone prior to commencing an exercise and/or sports program, or initiating a substantial change in the amount of regular physical activity performed. If I have chosen not to obtain a Physician’s consent prior to beginning this sports and agility camp with Heart and Hustle Sports, I hereby agree that I am doing so solely at my child’s own risk. In any event, I acknowledge and agree that assumes the risks associated with any and all fitness exercise activities and/or sports in which he/she participates. I acknowledge that I have thoroughly read this form in its entirety and fully understand that it is a release of liability. By signing this document, I am waiving any right I or my successors might have to bring a legal action or assert a claim against Heart and Hustle LLC for your negligence or that of your employees, agents, or contractors. I hereby grant Heart and Hustle Sports LLC permission to use and publish photos or videos of my child for educational and promotional purposes without compensation. Waiver of Liability Relating to Coronavirus/COVID-19 Heart and Hustle Sports cannot prevent you [or your child(ren)] from becoming exposed to, contracting, or spreading COVID-19 while utilizing Heart and Hustle Sport’s services or premises. It is not possible to prevent the presence of the disease. Therefore, if you choose to utilize Heart and Hustle Sport’s services and/or enter onto Heart and Hustle Sport’s premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19. ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my children in order to utilize Heart and Hustle Sport’s services and enter Heart and Hustle Sport’s premises. These services are of such value to me [and/or to my children,] that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize Heart and Hustle’s services and premises in person. WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against Heart and Hustle Sports and its owners, officers, directors, managers, officials, trustees, agents, employees, or other representatives in connection with exposure, infection, and/or spread of COVID-19 related to utilizing Heart and Hustle Sports services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen. CHOICE OF LAW: I understand and agree that the law of the State of New York will apply to this contract. I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE: I am the parent or legal guardian of the minor named above. I have the legal right to consent to and, by acknowledging with an affirmative consent below, I do hereby consent to the terms and conditions of this Release.

I consent to the aforementioned conditions