Tucson Interactive Sports, LLC

Parental Consent Agreement (For children ages 13-17) Minor's Name: First _______________________ M.I. _____ Last ________________________ Minor's Birth Date (MM/DD/YEAR): _______________________________________________ Address: ______________________________________________________________________ City: _____________________________ State: ______ Zip: ____________________________ Phone Number: (_____) _______ - _______________ Email Address: _________________________________________________________________ CERTAIN ATHLETIC EVENTS, INCLUDING VOLLEYBALL, ARE INHERENTLY DANGEROUS AND MAY NOT BE SUITABLE FOR CHILDREN UNDER 18 YEARS OF AGE. YOU HEREBY REPRESENT THAT THE ABOVE MINOR IS AT LEAST 13 YEARS OF AGE. I, ______________________________________________, the parent/guardian, hereby consent and give permission for my child/legal ward, _______________________________, to participate in the athletic event hosted by Tucson Interactive Sports, LLC on November 12, 2011 at the University of Arizona: Bear Down Gymnasium. I also grant full permission to Tucson Interactive Sports, LLC, its trustees, officers, members, and agents to use the name, likeness, and voice of my child/legal ward, as well as any photographs, videotapes, motion pictures, recordings, or any other record of this event in which my child/legal ward may appear. In consideration for your child/legal ward’s participation in this athletic event, you agree to assume full responsibility and liability for any property that is lost, stolen, or damaged. You also assume full responsibility for any minor or serious injury, accidental or intentional, to the above named child/legal ward while at the event or its surrounding areas. Should your child/legal ward need medical attention, you authorize Tucson Interactive Sports, LLC, its trustees, officers, members and agents to take any and all appropriate medical action(s), including administering first aid and/or contacting an ambulance/medical professional . You agree to release, waive, and discharge Tucson Interactive Sports, LLC, its trustees, officers, members, and agents from all liability for any and all loss or damage to property or injury to person(s) (including without limitation your child/legal ward). Additionally, we reserve the right to refuse service and/or payment to/from anyone. Any claim or controversy arising out of or relating to this Agreement, or the breach thereof, shall be settled by arbitration administered by the American Arbitration Association in accordance with its Commercial Arbitration Rules and judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. Any matter regarding payment of fees, including but not limited to bounced checks or other invalid methods of payment, may be litigated in small claims court or another appropriate venue by Tucson Interactive Sports, LLC. The laws of the State of Arizona shall apply to any arbitrated or litigated matter. Parent/Guardian Signature: _____________________________________________________ Print Name: __________________________________________________________________ Date: ________________________________________________________________________

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