Shannon Pohl Badminton Academy
First Name: Last Name: Cell Phone:
Date of Birth: Age: Gender: School:
Mother’s Name
(if under 18): Cell Phone:
Father’s Name
(if under 18): Cell Phone:
Emergency Contact
(if over 18): Cell Phone:
Health Conditions/ Current
Allergies: Medications:
Address: City:
State: Zip: Home Phone:
Parent Email
(if under 18): Player Email:
Group Class Private Lessons Open Gym Group Class Level:
(if applicable)
Shannon Pohl Badminton Academy Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreement (“Agreement”)
This Agreement is being entered into in consideration of my participation in The Shannon Pohl Badminton Academy (“Activity/Program”) and hereby represent
acknowledge that if I believe event conditions are unsafe, I will immediately discontinue participation in the Activity/Program. I fully understand that this Activity/Program
involves risks of serious bodily injury, including permanent disability, paralysis and death, which may be caused by my own actions, or inactions, those of others participating in
the event, Activity/Program, the conditions in which the event, Activity/Program takes place, or the negligence of the “releases” named below; and that there may be other risks
either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, cost, and damages I incur as a result
of my participation in the Activity/Program.
I hereby release, discharge, and covenant not to sue The Shannon Pohl Badminton Academy , Adversity Volleyball Center, Shannon Pohl Mitchell, its respective administrators,
Activity/Program takes place, (each considered one of the “RELEASEES” herein) from all liability, claims, demands, losses, or damages, on my account caused or alleged to
be caused in whole or part by the negligence of the “Releasees” or otherwise, including negligent rescue operations and in the future agree that if, despite this release, waiver
of liability, and assumption of risk, I, or anyone on my behalf, make a claim against any of the Releasees, I will indemnify, save, and hold harmless, each of the Releasees from
any loss, liability, damage, or cost, which any may incur as the result of such claim. Permission is also given to use my child’s photo or endorsement for promotion.
The parties agree that the substantive laws of the State of Illinois shall govern all matters concerning the validity, performance, administration, and interpretation of this
Agreement. The parties further agree that any judicial proceeding brought against The Shannon Pohl Badminton Academy on account of any dispute arising out of the
Agreement, or any matter related hereto, shall be brought in the courts of the State of Illinois or federal courts sitting in the State of Illinois. If any term, part, or provision of this
I have read the RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, understand that I have given up substantial rights by
signing it and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the
greatest extent allowed by law and agree that if any portion of this Agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect for a
period of one (1) year from the date hereof.
Printed name of Participant______________________________________________Signature of Participant____________________________________________________
Date:______________________
PARENTAL CONSENT
AND I, the parent and/or legal guaridan of ____________________________________,the Participant, who is minor under 18 years of age (“Minor”), understand the nature
agree to all foregoing terms and conditions of this Agreement, I hereby release, discharge, covenant not to sue and AGREE TO INDEMNIFY AND SAVE AND HOLD
HARMLESS each of the Releasees from all liability, claims, demands, losses or damages on the Minor’s account caused or alleged to have been caused in whole or in part as
a result of the Minor’s participation in the Activity/Program or by the negligence of the Releasees or otherwise, including negligent rescue operations, and further agree that if,
despite the release, I, the Minor or anyone in the Minor’s behalf makes a claim against any of the above Releasees, I WILL INDEMNIFY<SAVE AND HOLD HARMLESS each
of the Releasees from any litigation expenses, attorney fees, loss liability, damage, or cost and Releasee may incur as the result of any such claim.
Printed name of Parent _________________________________________________Signature of Parent_______________________________________________________
Date:______________________
2099 S. State College Blvd, Suite 600, Anaheim, CA 92806
Email: [email protected] Web: www.usabadminton.org
Phone: 714-765-2952
WAIVER AND RELEASE OF LIABILITY
Note: This form must be read and signed before the par cipant is permi d to take part in event sessions. By signing this
agreement, the par cipant a rms having read it.
In consider on of my involvement at the _Shannon Pohl Badminton Academy_ under the auspices of USA Badminton and the
Shannon Pohl Badminton Academy, I acknowlege, apprecaite, and agree that:
1. I risk bodily injury, including paralysis, dismemberment, disability, and death, and while par cular rules of the sport,
equipment, and discipline may reduce this risk, this risk of injury does exist, as well as the risk of damage to or loss of
property.
2. I knowingly and freely assume all such risk; both known and unknown, even if arising from the negligence of the releases of
others;
3. I willingly agree to comply with the state and customary terms and condi ons for par cip on. If, however, I observe any
unusual or unnecessary hazard during my presence or par cip on or if I observe any concern in my readiness for
par cip on, I will immediately bring such to the en on of the nearest o cial and refrai n from par cip on; and
3a. I, for myself, and on behalf of my heirs, assigns, personal representa ves and next of kin, herby release, hold harmless and
promise not to sue USA Badminton, the commi ee, their sponsors, their o cers, volunteers, sta , sponsors and/or agents,
(“releasees”) with respect to any and all injury and loss arising from my par cip on, whether caused by the negligence of the
releasees, the condi on of the premises or otherwise, except that which is the result of gross negligence or wanton
misconduct, to the fullest extent permi ed by law.
4. I agree to be bound by the rules and regul ons of the Badminton World Feder on and those of USA Badminton and I
hereby s pulate that I am eligible to play in the events for which I am applying and that I understand that the above
men oned make no represen on or warranty with respect to the condi on of the premises or the oper on of the event.
5. I hereby grant to USA Badminton, it’s licensees and contractees including photographers, television and m on picture rights
including to lm or videotape me during matches, narr ves, personal interviews, or comment thereon for any and all
commercial, news or other purposes together with the right to transfer or grant their rights to others, all without
remuner on or compens on to me whatsoever.
I have read this Release of Liability and Waiver Agreement, fully and understand the terms, understand that I have given up
substan al rights by signing it, and sign it freely and voluntarily without any inducement. And I further acknowledge by their
presence that I am aware that DRUG TESTING may occur at this event.
Par cipant’s Signature __________________________________________ Membership Number_______5254_____________
Par cipants Name (Printed) __________________________________________________ Date________________________________
For Par cipants of Minority Age
This is to cer fy that I/We as parent(s)/ guardian(s) with legal responsibility for this par cipant, do consent and agree not only to
his/her release, but also for myself, ourselves and my/our child involvement as stated above, EVEN IF ARISING FROM THE
NEGLIGENCE OF THE RELEASEES, to the fullest extent permi d by law.
Parent(s)’s/ Guardian(s)’s Signature(s)___________________________________________ Date_______________________________
Par cipants Name (Printed) ________________________________________Membership Number_____________________________
HOLD HARMLESS WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is
extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local
governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the
congregation of groups of people.
USA Badminton and the Shannon Pohl Badminton Academy has put in place preventative measures to reduce the spread of
COVID-19; however, USA Badminton and the Shannon Pohl Badminton Academy cannot guarantee that you or your child(ren) will
not become infected with COVID-19. Further, attending the Shannon Pohl Badminton Academy could increase your risk and your
child(ren)’s risk of contracting COVID-19.
It is my intent as a participant or player at the Shannon Pohl Badminton Academy, while participating during activities including any
pre-game or post-game activities that I am agreeable to the following:
I acknowledge that I am aware that there are risks to me of exposure to directly or indirectly arising out of, contributed to, by, or
resulting from an outbreak of any and all communicable disease, including but not limited to, the virus “severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2)”, which is responsible for COVID-19 and/or any mutation or variation thereof;
IN CONSIDERATION OF HAVING THE OPPORTUNITY TO PARTICIPATE AT THE SHANNON POHL BADMINTON
ACADEMY, AND IN ACKNOWLEDGING THAT I HAVE READ THIS HOLD HARMLESS WAIVER AND
ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP
SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY, VOLUNTARILY, KNOWINGLY AND WILLINGLY
WITHOUT ANY INDUCEMENT.
By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I
may be exposed to or infected by COVID-19 by attending the Shannon Pohl Badminton Academy and that such exposure or infection
may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by
COVID-19 at Shannon Pohl Badminton Academy may result from the actions, omissions, or negligence of myself and others,
including, but not limited to, Shannon Pohl Badminton Academy employees, volunteers, and program participants and their families.
I hereby voluntarily agree to assume all of the foregoing risks, hold harmless, and indemnify USA Badminton and its trustees, agents,
volunteers and employees from any and all claims, demands, damages and causes of action of any nature whatsoever arising out of
ordinary negligence which I, my heirs, my assigns or successors may have against them for, on account of, or by reason of my
participation in the above activities. I also accept sole responsibility for any injury to my child(ren) or myself (including, but not
limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren)
may experience or incur in connection with my child(ren)’s attendance at Shannon Pohl Badminton Academy (“Claims”). On my
behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless both USA Badminton and
Shannon Pohl Badminton Academy, their employees, agents, and representatives, of and from the Claims, including all liabilities,
claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release
includes any Claims based on the actions, omissions, or negligence of USA Badminton and/or Shannon Pohl Badminton Academy and
its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation.
This Agreement shall be governed by, and construed in accordance with, the laws of the State of Illinois.
Name of participant: ______________________________________
Participant signature: _______________________________________ Date signed: ____________________
FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)
This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this
waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to
the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these
risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above and agree to
indemnify and hold harmless USA Badminton and Shannon Pohl Badminton Academy for any and all liabilities incident to my minor
child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to
the fullest extent provided by law.
Name of parent/guardian: ____________________________________
Parent guardian/signature: ____________________________________ Date signed: ___________________
