Name
*
First Name
Last Name
Sport(s)
*
Date of Birth
*
MM
DD
YYYY
Travel Organization
Athlete’s Name
*
First Name
Last Name
Grade they will enter starting Aug 2023
*
6th Grade
7th Grade
8th Grade
Parent/Guardian’s Name
*
First Name
Last Name
Home Phone
*
(###)
###
####
Work Phone
*
(###)
###
####
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
*
Secondary Emergency Contact
*
First Name
Last Name
Phone Number
*
(###)
###
####
Hospital/Clinic Preference
Physician’s Name
Policy Number
Insurance Company
*
Allergies/Special Health Considerations
*
Card Number
*
Card Holder Name
*
First Name
Last Name
CVV
*
Signature Date
*
MM
DD
YYYY
Signature Date
*
MM
DD
YYYY
COVID-19 Acknowledgment
*
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 a EM Sports Facility, 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 by attending an EM Sports Facility may result from the actions, omissions, or negligence of myself and others, including, but not limited to, City employees, volunteers, and program participants and their families.
Signature Date
*
MM
DD
YYYY
EM Personal Training Agreement
*
This Personal Training Agreement (the “Agreement) is entered into between participant (“Client”) and EM Sports L.L.C., and/or EM Speed & Power Training (“EM”). The parties hereby agree as follows:
1. Performance of Services.
EM Sports / EM Speed and Power Training (furthermore referred to as EM), agrees to provide personal or group training services (the “Personal Training Services”) to client. The Personal Training Services shall be preformed at an agreed upon site.
2. Payment Terms, Terms and Termination.
EM shall perform Personal Training Services. Clients agree to pay EM for the Personal Training Services, payable in full on or before the Start Date. REFUNDS-EM DOES NOT OFFER REFUNDS FOR TRAINING.
3. Amendments.
The Agreement may not be altered or modified except by a writing signed by the Parties.
4. Arbitration.
Disputes arising from this Agreement are subject to arbitration pursuant to the Commercial Industries rules of the American Arbitration Association and shall be conducted by a neutral arbitrator. The arbitration shall allow for reasonable discovery as agreed to by the parties or as directed by the arbitrator. The result of such arbitration shall be reduced to writing and will be binding upon both Client and EM. The prevailing party in the arbitration proceeding shall be entitled to recover reasonable cost, including attorney’s fees, as determined by the arbitrator. The Parties further agree that in any dispute resulting in arbitration or litigation venue shall be Los Angeles County, California.
5. Attorneys’ Fees and Interest: Governing Law.
This Agreement shall be governed by and construed according to the laws of the State of California that would apply if all parties were residents of California and the Agreement was made and performed in California. In any dispute between the Parties, whether or not resulting in litigation, the party substantially prevailing shall be entitled to recover from the other party all reasonable costs, including, without limitation, reasonable attorneys’ fees. In addition, such prevailing party shall be entitled to interest at ten percent (10%) per year from the date any amount should have been paid until the date such amount is paid.
6. Notices.
All notices and demands between the Parties hereto shall be in writing and shall be served either personally or by registered or certified mail. Such notices or demands shall be deemed given when personally delivered or seventy two (72) hours after the deposit thereof in the United States mail, postage prepaid, addressed to the party to whom such notice or demand is to be given or made. All notices and demands shall be given to the person and at the address listed on the first page of this Agreement, or by using the email address set forth under his or her name. Each party may designate in writing such other places that notices and demands may be given.
7. Non-Solicitation of Employees, Agents and/or Independent Contractors.
Client acknowledges that EM’s employees, agents and/or independent contractors are a valuable asset in the operation of EM’s business. During the term of this Agreement and for a period of three years immediately following the termination of the Training Session, Client shall not directly or indirectly solicit, hire, recruit or encourage and employee, agent or independent contractor of EM to cease providing services to EM and/or to work for Client or any other person or entity.
8. Employment of Assistants and Nonexclusive Service.
EM may, at EM’s own expense, employ such employees, agents and independent contractors as EM deems necessary to perform the Personal Training Services required of EM by this Agreement. Client may not control, direct, or supervise EM’s employees, agents and/or independent contractors or EM in the performance of the Personal Training Services provided under this Agreement. EM and its employees, agents and/or independent contractors may represent, perform services for, and/or be employed by such additional companies, persons, or clients as EM, in EM’s sole discretion, chooses.
9. Status of EM.
EM will remain an independent contractor of Client. Neither EM nor its agents or employees shall become an employee, joint venture, partner, agent or principal of the Client during the term of this Agreement. No payroll or employment taxes of any kind shall be withheld or paid with respect to the payments made by Client to EM.
10. Video, digital image release.
I hereby give permission for images of my child, captured during EM training or events through video, photo and digital camera, to be used solely for the purposes of EM’s promotional material, publications and social networking and waive any rights of compensation or ownership thereto.
Parental/Guardian Consent & Waiver
*
I am aware and acknowledge that my child’s participation in the personal speed and power training conducted by EM poses the potential risk of injury/illness to my child.
For and in consideration of the opportunity for my child to participate in such personal training activities, I hereby voluntarily release, discharge, waive, and hold harmless EM, it’s officers, managers, members, agents, or employees (collectively “EM”) from any and all actions or causes of action for personal injury, bodily injury, property damage, or wrongful death (the “claims”) occurring to my child arising in any way whatsoever as a result of my child’s participation in such training activities.
I furthermore agree to indemnify and defend EM against any such Claim for personal injury, bodily injury, property damage, or wrongful death arising in any way whatsoever as a result of my child’s engaging in the above-described personal training activities.
I also give EM, and its employees, agents and/or independent contractors in case of emergency, permission to have my child treated and authorize emergency medical personnel permission to treat upon my absence.
Pre-Existing Conditions
*
Check all that apply and explain any checked answers in detail in the Explanation comment box below:
Explanation or Other Conditions
Medication A
Medication A - Dosage & Frequency
Medication B
Medication B - Dosage & Frequency
Medication C
Medication C - Dosage & Frequency
Additional Medications
List any additional medications, dosages, and frequencies.
Drug Allergies or Reactions to Medications/Other Agents
If "Yes", please list in the box below:
