Terance Mathis Youth Camp

Verification of Information, Consent to Background
Check, Permission to Use Image, Release and Waiver of Liability

I request that my child (identified above) be permitted to participate in an activity sponsored by Terance Mathis Educational Institute, Elite 1 Performance, or ESC and agree to the following: I understand and agree that my child’s participation in this activity may expose him/her to risks of injury or death. The risks include but are not limited to: death, injury, serious neck and spinal injuries, paralysis, brain damage, and injury to vital organs, bones, joints, muscles and tendons. I will counsel my child so he/she understands that it is important for his/her safety and the safety of others to follow all instructions of the coaches and staff. I agree that I am responsible for my child’s conduct while he/she is participating at the activity.

In consideration for my child’s participation in this activity, on behalf of myself and my child, I release discharge, and hold harmless the State of GA AND NM, Terance Mathis Educational Institute, Elite 1 Performance, or ESC and their officers, coaches, volunteers, employees and agents from all liability, claims, costs, and expenses arising out of these activities which may result in injury or illness to my child. I also agree to defend and indemnify the State of GA AND NM, Terance Mathis Educational Institute, Elite 1 Performance, or ESC and their officers, coaches, volunteers, employees and agents aGA and NMinst any claims arising out of my child’s participation in the activity.

I further agree that the Athletics Department Staff, the Terance Mathis Educational Institute, Elite 1 Performance, or ESC are authorized to obtain and authorize emergency medical treatment for my child up to and including emergency hospitalization and surgery. I agree to be personally responsible for any related medical expenses.

On behalf of my child, and myself, I further release the State, Terance Mathis Educational Institute, Elite 1 Performance, or ESC from any liability arising out of the emergency medical treatment obtained.

I also release Terance Mathis Educational Institute, Elite 1 Performance, or ESC from any claims for the loss of personal property and agree that Terance Mathis Educational Institute, Elite 1 Performance, or ESC may use, for publicity and advertising purposes, photographs of my child taken during participation in the activity. A copy of this agreement shall suffice as original.