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Reagan Martin

Before You Train

Before You Train

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Legacy 6 Athlete and Coach Waiver

Legacy 6 Athlete and Coach Waiver

LEGACY 6 INC.
319 W. Broad Street, Suite A • Central City, KY 42330
ANNUAL PARTICIPANT WAIVER, RELEASE OF LIABILITY,
ASSUMPTION OF RISK & INDEMNIFICATION AGREEMENT

Participant Information

Participant Name
_____________________

Date of Birth
_____________________

Parent/Guardian
_____________________

Relationship
_____________________

Address
_____________________

City/State/ZIP
_____________________

Phone
_____________________

Email
_____________________

Emergency Contact
_____________________

Emergency Phone
_____________________

Program/Class
_____________________

Coach Assigned
_____________________

Effective Date
_____________________

Expiration Date (1 Year)
_____________________

Purpose

Applies to all Legacy 6 Inc. activities.

Participant/Guardian Initials: __________

Assumption of Risk

All athletic participation carries inherent risks which are voluntarily assumed.

Participant/Guardian Initials: __________

Release of Liability

Participant releases Legacy 6 Inc. and its owners, coaches, employees, volunteers, and contractors from claims arising from ordinary negligence to the fullest extent permitted by Kentucky law.

Participant/Guardian Initials: __________

Coach Protection

Individual coaches shall not be personally liable for injuries arising from ordinary coaching, instruction, spotting, or supervision.

Participant/Guardian Initials: __________

Medical Authorization

Emergency treatment is authorized if needed.

Participant/Guardian Initials: __________

Acknowledgment

I have read, understand, and voluntarily sign this agreement.

Participant/Guardian Initials: __________

Coach & Signature Information

Primary Coach

_____________________

Certification(s)

_____________________

Assistant Coach

_____________________

Certification(s)

_____________________

Participant Signature

_____________________

Date

_____________________

Parent/Guardian Signature

_____________________

Date

_____________________

Legacy 6 Representative

_____________________

Date

_____________________

Witness

_____________________

Date

_____________________

Final Initials

_____________________

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Legacy 6 Athlete Participation Waiver And Release of Liability

Legacy 6 Athlete Participation Waiver And Release of Liability

Thanks for contacting us!

We will be in touch shortly.
If you contacted us outside of business hours it might take us a bit longer to respond.