Name *

First Name

Last Name

Phone *

(###)

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cost Acknowledgement *

I acknowledge that if offered a spot, the full program fee will need to be paid upfront.

I understand

PARENTAL WAIVER AND CONSENT *

As the parent/guardian of an ultimate player(s) under the age of 19, I have asked that my child/children be allowed to join Prime Ultimate Club (PUC) in order to participate in one or more programs or events (Game Play). I understand that the sport of ultimate, as an extreme test of a person's physical and mental limits, may involve physical risk including the potential for death, serious injury, property injury, or property loss. I hereby agree freely and expressly to assume and accept any and all injuries and losses my child/children may incur while participating. In consideration of the PUC allowing my child/children to participate in Game Play, I, for my child/children, myself, my heirs, executors, administrators, successors and assigns, hereby release, waive and forever discharge Prime Ultimate Club, its sanctioning body and sponsors and all their respective agents, servants, contractors, representatives, directors, elected and appointed officials, successors and assigns, of and from all claims, demands, damages, costs, expenses, actions and causes of action, whether in law or in equity, in respect of death, injury, loss or damage to my person or property howsoever caused, arising to or by reason of my participation in the aforementioned event, whether as a spectator, participant, competitor or otherwise, whether prior to, during, or subsequent to the current calendar year and notwithstanding that same may have been contributed to or occasioned by the negligence of any of the aforesaid. I further hereby undertake to hold and save harmless and agree to indemnify all of the aforesaid from and against any and all liability incurred by any or all of them arising as a result of, or in any way connected with, my child’s/children’s participation in PUC Game Play. I understand that the PUC and/or its authorized representatives may occasionally take pictures during PUC programs and events. I agree that the PUC shall maintain ownership of such pictures and consent to the use of same, as it pertains to my child, for PUC promotional materials and Web content. By checking below, I acknowledge having read, understood and agreed to the above consent, release, waiver and indemnity for the individual in the form.

I AGREE