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Click here to manually download a copy of our liability waiver.

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* Student’s Name:

*DOB (MM/DD/YY):

* Email Address:

* Street Address:

* City:

* State:

* Zip Code:

* Parent/Guardian Name:

* Parent/Guardian Phone:

* Emergency Contact Person:

* Emergency Contact Phone:

* Relationship to the child:

* Health Insurance:

Yes No

* Allergies:

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* Physical Limitations:

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* Select the program you are registering for:

MEDICAL RELEASE AND LIABILITY WAIVER

I hereby authorize and give my consent for my child’s participation in Legacy Sports and Life Skills, Corp. training programs and events. The undersigned expressly ACKNOWLEDGES, UNDERSTANDS AND AGREES that the activities offered by Legacy Sports & Life Skills Corp. involve the risk of injury and/or death and/or property damage. Accordingly, the undersigned ACKNOWLEDGES that Legacy Sports & Life Skills Corp. and/or its OFFICERS, COMMISSIONERS, EMPLOYEES OR AGENTS, INCLUDING HILTON HOTEL, COCOA BEACH, OCEANFRONT, C. KING CENTER FOR THE PERFORMING ARTS OF BREVARD COMMUNITY COLLEGE, BREVARD PUBLIC SCHOOLS, EXCEPTIONAL STUDENT EDUCATION, AND HOLY NAME OF JESUS CATHOLIC all for the purposes herein referred to as “RELEASEE” are not responsible for any bodily injury, death or property damage sustained while participating in the Legacy Sports & Life Skills Corp. activities. The undersigned HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE, RELEASEE from any and all liability to the above named PARTICIPANT/CHILD, his or her personal representatives, assigns, heirs, and next of kin for any and all injury, death, loss, or damage, and any claims or demands therefore whether caused by negligence of RELEASEE or otherwise while the above-named PARTICIPANT/CHILD is participating in the activities.

In the event that the above named PARTICIPANT/CHILD sustains physical injury while participating in the above referenced activity or activities, I hereby authorize and request that said PARTICIPANT/CHILD receive emergency treatment from individuals licensed by the State of Florida as a medical Service unit as well as any hospital in the State of Florida.

The UNDERSIGNED further expressly agrees that the foregoing AGREEMENT, WAIVER AND RELEASE is intended to be as broad and inclusive as is permitted by the laws of the state and county and that if any portion thereof is held invalid, it is agreed that the balance shall notwithstanding continue in full legal force and effect.

The UNDERSIGNED HAS READ AND VOLUNTARILY signs this AGREEMENT, WAIVER AND RELEASE and further agrees that no oral representations, statements or inducements apart from the foregoing written agreement have been made.

I further grant the released parties the right to photograph and/or videotape my child and to use these photographs and media materials as well as my child’s name, face, likeness, voice and appearance in connection with newsletters, publicity, advertising, promotional or Internet materials without reservation, compensation, or limitation. The released parties are, however, under no obligation to exercise said rights herein granted. I, as the parent/legal guardian for the above listed youth, attest that I am at least 18 years of age.

* I have read and accept the Medical Liability and Release Waiver

All Legacy Sports programs are nine month programs for girls and boys at $79 per month. Each program will have different age requirements, so please review the program age requirements prior to enrolling. A weekly registration is available at $25 per week. Winter and Spring break sessions will be available as a separate registration. Summer sessions are six weeks in length and are a separate registration. A 5% transaction fee will be added to all online registrations. All monthly particpants will have priority for the vacation sessions. There is a no refund for any reason policy. Legacy Sports has the right to refuse any participant from participating for behavior that is not in line with the Legacy Sports & Life Skills conduct code.