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Gonna Fly Now
Presented by
CrossFit Beaufort Olympic Weightlifting
Date: Saturday, August 13th, 2016
Location: CrossFit Beaufort
1000 Hamar Street Beaufort, SC 29902
Lifting Begins @ 10:00 a.m.
LAST NAME: ______________________________ FIRST NAME:_______________________
ADDRESS______________________________ CITY_____________ STATE___ ZIP________
PHONE (_______) ____________________ E-MAIL _________________________________
WEIGHT CLASS: ________KG MALE:________ FEMALE: _______
AGE : _____ DOB: ____________ USAW #: ___________________
COACH: ______________________ USAW CLUB AFFILIATION:________________________
PLEASE TYPE OR PRINT ALL INFORMATION CLEARLy: Please enter me in the "Gonna Fly Now" Weightlifting Meet. I certify that I am an amateur athlete in good standing. In consideration of my entry in the competition, I do hereby waive, and release CrossFit Beaufort, LLC and their respective directors, officers, officials, agents and competition personnel, hereinafter known as the "Organizers," from any and all causes of action, loss, liability, claims and demands of every kind and nature, which I or my heirs or personal representatives may have for bodily injury, for expenses of medical treatment, hospitalization, and other care rendered to me in the event of my injury or illness, except that the forgoing waiver and release shall not apply to injuries, damages, and losses resulting from the gross negligence and/or wanton misconduct of the Organizers or to bodily injuries and medical expenses covered by accidental death, dismemberment and/or loss of sight and medical reimbursement insurance policies maintained by the Organizers.
I agree to be filmed and photographed under conditions approved and authorized by the Organizers of my weightlifting performance and authorize its use in promoting the competition and the success of the weightlifting team on which I compete, to promote the image of the Organizers, USA Weightlifting, its sponsors and advertisers, and the sport of amateur weightlifting.
I (and my parent or guardian, if I am a minor), agree that I will be financially responsible for treatment, hospitalization and other medical care rendered to me in the event of my illness, injury or other emergency circumstances in connection with the competition, except to the extent my injuries and medical expenses, if any, are covered by accidental death, dismemberment and/or loss of sight and medical reimbursement insurance policies maintained by the Organizers for my benefit, in which event I will nevertheless continue to be financially responsible for expenses of treatment, hospitalization and other medical care in excess of such policies' limits.
ATHLETE’S SIGNATURE: _____________________________________ DATE: ____________
UNDER AGE ATHLETES
ATHLETES WHO WILL BE UNDER 18 YEARS OF AGE ON THE DATE OF THE COMPETITION MUST HAVE THE FOLLOWING SECTION COMPLETED BY A PARENT OR GUARDIAN.
I have explained to my son/daughter the aforementioned releases and conditions and their ramifications and I further consent to his/her registration for this USA Weightlifting activity under the above stipulated conditions.
PARENT SIGNATURE____________________________________ DATE__________________
PARENT OR GUARDIAN PRINTED NAME: ___________________________________________