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Physical Fitness for Life

Student Name :

Student Name :


(#418808) Birthdate:



Name of adult on account:

Rachel Jennings




402 N Clementine St Apt 2, Oceanside, CA 92054




Alt Email:

Emergency Contact:

Caulin Jennings 760-645-5151

1. EMH Sports U.S.A.(hereafter EMH Sports) is committed to conducting athletic programs and activities in the safest manner possible and holds the safety of participants in the highest regard.

2. I hereby waive, release and discharge for my child, myself, my heirs, legal representatives, next of kin, executors, administrators, assignees, and successors in interest (collectively referred to as "Successors" any and all rights and claims for damages, injuries (including death), expenses or costs of any kind (collectively referred to as "Claims" which I have now or may acquire in the future that are directly or indirectly related to my participation in the Activities, against EMH Sports and its agents, officials, employees, volunteers and contractors, (collectively referred to as the "Released Parties". The waived, released and discharged Claims include claims arising from the Released Parties' own active or passive negligence.


3. I acknowledge that the Activities are recreational, that my child is not required to participate in them, but that I want to participate and do so voluntarily.


4. I hereby agree to indemnify the Released Parties from any and all liability for all damages including personal injury, death, disability, property damage or other loss, to any third party resulting from or related to my participation in the Activities.


EMH SPORTS USA, INC. Student Risk & Waiver of Liability Relating to Coronavirus/COVID-19


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. EMH Sports USA, Inc. is taking extra precautions with the care of every student to include health history review and enhanced sanitation/disinfecting procedures in compliance with CDC guidance. EMH Coaches will wear face coverings during the entire sessions and will sanitize their equipment before sessions are conducted. Although EMH Sports USA, Inc, has put in place preventative measures to reduce the spread of COVID-19; EMH cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the “in person” PE sessions at your park location could increase your risk and your child(ren’s) risk of contracting COVID-19. Symptoms of COVID-19 include: • Fever • Fatigue • Dry Cough • Difficulty Breathing I understand the above symptoms can indicate illnesses other than COVID-19, but can also be indicators of COVID-19, and therefore I affirm that I and my child(ren), as well as all household members, will not attend in-person classes if any of us currently have the symptoms listed above, or have experienced any within the last 14 days or have been diagnosed with COVID-19 within the past 30 days. I affirm that I and my child(ren), as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days NOR that I and my child(ren), as well as all household members, have not traveled outside of the country or to any city considered to be a “hot spot” for COVID-19 infections within the past 30-days. In consideration for receiving “in person” PE services from EMH Sports USA, Inc. at my selected park location, I, on behalf of myself and any minor child/children for whom I have the capacity to contract, hereby acknowledge and agree to the following: Notwithstanding the risks associated with COVID-19, I hereby willingly choose to participate with “in person” PE instruction. Masks maybe required if County/State mandates change, and my child will wear face coverings during the sessions. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the EMH in person PE sessions and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at these sessions and may result from the actions, omissions, or negligence of myself and others, including, but not limited to, EMH employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury or illness upon my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the in person APE sessions (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless EMH Sports USA, Inc., its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of EMH Sports USA, Inc., its employees, agents, and representatives, whether the injury or illness occurs before, during, or after participation in any EMH PE session.


The undersigned has read, understands and voluntarily signs this release agreement

I have read and understand this entire Agreement and its terms. I understand that by signing this Agreement, I assume all risks and waive and release certain rights that the Participant and his or her heirs, next of kin, family, relatives, guardians, executors, administrators, trustees and assigns may have against EMH Sports, it's agents, instructors, contractors, officials, volunteers, employees. As the parent or guardian of the above named minor, I hereby give permission for my child or ward to participate in the Activities. I further agree, individually and on behalf of my child or ward, to all of the terms stated above.



Electronic Submission This form and the electronic submission thereof is a legally binding contract and can only be completed by the parent or legal guardian of the participant. By submitting this form you declare that you have the authority to do so. I hearby certify that I am the parent or legal guardian of the participant listed above, and that I have the authority to and do hearby sign this legally binding document, having read and agreed to all of the above conditions.

I agree

(Mom) Thu. Dec 8, 2022 - 10:23 am



6. I agree for myself and Successors that the above representations are contractually binding and are not mere recitals, and that if I or my Successors assert a claim in contravention of this Agreement, the asserting party shall be liable for all expenses (including attorneys' fees and court costs) incurred by the other party or parties to defend that claim, unless the other party or parties are finally adjudged liable on such claim for willful and wanton negligence. This Agreement may not be modified orally. Waiver of any provision shall not be construed as a waiver or modification of any other provision of this agreement. Every term and provision of this Agreement is severable. If one or more provision is found to be unenforceable or invalid, the remaining terms and provisions shall remain binding and enforceable.


7. I authorize EMH Sports or its contractor to provide such medical treatment to the Participant listed above as may be deemed necessary or appropriate if my child is injured while participating in any of the Activities. And I agree that I will be responsible for payment of any and all medical services rendered.


8. I hereby grant full permission for the free use of name and/or any photographs, videotapes, motion pictures, recordings and/or any other record taken during our events for any legitimate purpose.

5. Medical Details 

5. Medical Details No Allergy

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