Fencer Waiver and Release of Liability *

I understand and appreciate, although proper precautions of attire and safety are strictly observed at Still Point Fencing Studio, that participation in any sport carries a risk of serious injury or death. While observing the rules of conduct and adhering to the safety rules, I knowingly accept and assume this risk and release the Still Point Fencing Studio, their sponsors, instructors, coaches and officers from any liability, I willingly agree to comply with the stated and customary terms and conditions for participation in this sport. If however, I observe any unusual or unnecessary hazard during my presence or participation, I will bring such to the attention of the nearest official immediately. This is to certify that I/we as parent(s)/guardian(s) with legal responsibility for this fencer do consent and agree not only to my/his/her release, but also for myself/ourselves, and my/our heirs, assignees and next of kin to release and indemnify the releases from any and all liability incident to my/our minor child's involvement as stated above, even if arising from the negligence of the releases, to the fullest extent permitted by law.

I affirm I have read the waiver and release of liability and agree with its terms

Fencer Name *

First Name

Last Name

Fencer Birthdate *

Used to determine eligibility for USA Fencing Tournaments

MM

DD

YYYY

Parent/Legal Guardian Name

Required if the fencer is a minor

First Name

Last Name

Today's Date *

MM

DD

YYYY

Checkbox *

I agree to give Still Point Fencing Studio permission to use the name, image, likeness, voice and/or appearance of my me/ my child in any photographs, video, recordings, digital images and the like made on behalf of me/ my child in their capacity as a student. I understand that the permissions I have granted will apply to both current and future use of promotional or educational materials. I acknowledge that I will not receive any compensation for the use of me/ my child's name and recordings. I understand that any change to my consent must be made by written request. I hereby hold harmless Still Point Fencing Studio from any and all actions, claims, damages costs, or expenses which relate to or arise out of any use of these recordings as specified and agreed to above. I have read and understand this consent and release and I hereby give my consent to use me/ my child's name, likeness, image, voice and/or appearance (Recordings) to promote Still Point Fencing.

Yes, I agree to the above terms

No, I decline the above Photo Release Form

Date *

MM

DD

YYYY

Cardholder Name *

First Name

Last Name

Card Type

MasterCard

VISA

Discover

AMEX

Other

Credit Card Authorization *

I agree and authorize Still Point Fencing Studio to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account.

Yes I consent to the above authorization