I do hereby -

MEDICAL AUTHORIZATION - authorize New England Sports Academy, LLC (NESA) to transport my child and/or ward to a doctor, hospital or other health care facility and to act in my place to obtain medical or hospital treatment.

RELEASE OF LIABILITY/INDEMNITY FOR PERSONAL INJURY - release NESA, it's owners, instructors, employees, agents and servants, from any and all liability for personal injury to me and/or my child and/or ward as the result of any negligence arising out of or in the course of or in any way related to my or my child's use of the facilities, equipment, apparatus or premises of NESA and/or my or my child's participation in any class, program, competition or other event organized, run and/or sponsored by NESA, whether at its facilities or elsewhere. On behalf of myself and my child and/or ward, I agree to indemnify and hold harmless the said NESA and its owners, operators, instructors, employees, agents and servants from any and all claims, damages, demands, costs, expenses and compensation arising out of or in he course of or in any way related to any personal injury to me or my child.

USE OF IMAGES/NAME IDENTIFICATION - authorize NESA to use images of me and/or my child and/or ward, both with and without name identification, for NESA publicity, promotional and advertising purposes and release any and all claims and/or rights I and/or my child and/or ward might have as a result.

ACKNOWLEDGEMENT OF ACTIVITY RISKS - acknowledge my understanding and acceptance of the following:

1. that the activities offered by NESA include active sports which can result in injury to participants and/or spectators;

2. that NESA provides an observation area and that I have the option to remain in the observation area while my child and/or ward is in a class, working out or performing;

3. that in the event I choose to leave my child and/or ward before, during or after a class, workout or a performance, I hereby give NESA my permission to use its discretion in determining whether my child and/or ward requires medical attention and, if so, to use its discretion in transporting my child and/or ward, selecting a health care facility and obtaining treatment for him/her;

4. that in my absence NESA does NOT assume any responsibility for the care, custody, control, condition, health or well being of my child and/or ward.

ACKNOWLEDGEMENT OF RULES AND POLICIES - acknowledge that NESA has rules and policies in place regarding safety, use of facilities, conduct and the like. I have reviewed all currently in place (copies always available at NESA facilities). I understand that failure to follow the rules in NESA's discretion may result in revocation of all privileges provided by NESA without refund of any prepaid fees.

By checking this box, I certify that I have read and agree with the above AUTHORIZATIONS, RELEASES AND ACKNOWLEDGEMENTS.