Register your child for tutoring & training Youth's Information Name * First Name Last Name Birth Date * MM DD YYYY Current Grade * Gender * F M Other Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone (###) ### #### What subject(s) tutoring is needed in? * Parent/Guardian Information Name * First Name Last Name Relationship to Youth * Email * Cell Phone * (###) ### #### Secondary Number (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Emergency Contact Note: We will only contact this person if IAA ATHLETICS is unable to reach parent(s)/guardian(s) Name * First Name Last Name Phone * (###) ### #### Email * RELEASE WAIVER In consideration of my child’s, participation in IAA's Tutoring and Athletic Training Program (which meets regularly on a predetermined day of the week) I hereby agree on behalf of myself, my heirs, legates, executors, administrators, and personal representatives, to release and hold harmless all staff and coaches, and any and all other persons and organizations assisting IAA, from liability for any injury to my child, to my child’s property and any and all claims in any manner arising from or associated with my child’s participation whether the liability, loss or damage is caused in whole or in part by their failure to use reasonable care in their activities associated with IAA. I understand that in case of emergency, IAA staff and all other coaches have my total permission to use their best judgment in matters of treatment and to have my child treated accordingly. * I give permission for my child to participate in tutoring. I acknowledge that this athletic / tutoring event is an extreme test of a person’s physical and mental limits and carries with it the potential for serious injury, death and property loss. The risks include, but are not limited to: actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, event monitors and/or producers of the event; lack of hydration, weather, and/or other natural conditions. I hereby assume all of the risks of participating in this event. I understand that at this event or related activities I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and/or assigns. I hereby certify that I have read this document and I understand its content. Parent/Guardian's Signature * Thank you!
