3rd Avenue Sports (DBA) Collegeville Sports Academy (CSA)
MINOR WAIVER & PHOTO/VIDEO RELEASE FORM

I hereby indicate that I am the parent and/or legal guardian of the Participant(s) listed below (hereinafter each a “child”). I give my child permission to
participate in any and all activities Collegeville Sports Academy (CSA) including but not limited to those activities related to the program/organization
identified below. I am in agreement with all of the terms of this Waiver, and I maintain the authority to enter into this Waiver on behalf of my child,
myself, and all legal parties/guardians of my child. This waiver covers my activities at CSA at any time, during calendar years 2023-2024,
and in the future beyond calendar year 2024.

I acknowledge that some activities in which my child may participate at CSA have certain dangers. Accidents may occur, and he/she could sustain
injuries, or even die as a result of these risks. Property damage may also occur as a consequence. Acknowledging these risks, I hereby knowingly and
voluntarily assume all risk of injury on my child's behalf while he/she is participating in the activities at CSA. Understanding the inherent risks in
participating, I affirm, to the best of my knowledge, that my child has no medical, physical, and/or emotional health conditions which would hinder
his/her participation. I certify that my child is physically fit, has been sufficiently trained to participate in this activity, and has not been advised
otherwise.

In consideration of my request and permission for my child to participate in any and all activities at CSA, I hereby agree on my own behalf, to release
and forever discharge CSA, as well as its owners, agents, employees, heirs and executors from any and all liability for injuries, death or property
damage, arising or resulting from, or any other way connected with, my child's participation. The term of this Waiver applies to myself, my child, our
heirs, executors, administrators, assigns, successors, spouse, personal representatives, agents, legatees, other parents, and/or legal guardians of my
child, and all family members. I agree that this Waiver shall cover my child's participation in any and all activities, including but not limited to, practice
or instructional sessions, and any activity taught by the coaches, league representatives or other instructors or agents, as well as programs directed by
CSA staff members or agents.

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 from being in close proximity with others. 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. CSA
and its employees cannot guarantee that you, your player, or others associated with you will not become infected with COVID-19 (or any illness). By
signing this agreement, you acknowledge on behalf of yourself, your player(s), your family, and anyone else connected to you the contagious nature of
COVID-19 and voluntarily assume the risk for all involved of being exposed to or infected by COVID-19 (or any illness), and that such exposure or
infection may result in personal injury, illness, permanent disability and death. You understand that there is risk of becoming exposed to or infected by
COVID-19 (or any illness). You understand and agree that this release includes any claims based on the actions, omissions, or negligence of CSA and is
employees and anyone else associated with CSA, whether a COVID-19 infection (or any infection) occurs before, during or after participating in any
activities on CSA’s premises or otherwise associated with CSA.

I agree to indemnify CSA, and hold CSA harmless, from any and all liability (including attorney’s fees, paid directly or indirectly) arising out of, whether
directly or indirectly, my child’s involvement or participation in activities at CSA.

I give permission to Collegeville Sports Academy to obtain on my child's behalf, any emergency treatment. In case of sickness, accident, illness or
injury, CSA has my express permission to secure such medical attention as is deemed necessary in the sole discretion of CSA.
CSA has my permission to use my or my child’s photograph publicly to promote the facility. This waiver gives CSA permission to use photographs
and/or video recordings of any events that takes place on CSA property. I understand that the images may be used in print publications, online
publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by
reason of such use. I waive the right to approve the final product. I agree that all such portraits, pictures, photographs, video and audio recordings,
and any reproductions thereof, and all plates, negatives, recording tape and digital files are and shall remain the property of CSA. I hereby release,
acquit and forever discharge CSA from any and all claims, demands, rights, promises, damages and liabilities arising out of or in connection with the
use or distribution of said photographs and/or video recordings, including but not limited to any claims for invasion of privacy, appropriation of likeness
or defamation.

Participant Name(s) and DOB:

Parents' Names and Contact Numbers (Emergency Contact Info):

Participant Address:

Participant Phone:

Participant Email:

Organization’s Name/Program:

School Name & District:

I have read and understand all of the information presented to me in this Waiver & Release Form and understand the terms and agreement. Lastly, I agree to accept and abide by the rules and regulations of the programs, coaches and/or referees, and the CSA facility itself.

Parent's Signature