Riverbend Combat Association: MINOR Participant Release

Real Name of Minor Participant__________________________________________

Birth Day of Minor Participant (Month/Day/Year)___________________________________

Character Name___________________________________________

In order to participate in Riverbend Combat Association, this release form must be completed in it's entirety by each Participant's parent(s)/guardian(s) AND have notarized parent/guardian signature. If this form is not filled entirely filled out and/or notarized, the minor participant will not be allowed to participate.

I/We, the parent(s) or legal guardian(s) of the Participant, a minor, hereby expressly forever release and discharge all group leaders, Riverbend Combat Association and/or any of their affiliate companies, employees and agents, from any claims, demands, injuries, damages or causes of actions for personal injury or for theft, loss or damage to personal property, or for any matter whatsoever, resulting from their participation in Riverbend Combat Association activities.

I/We further understand that the Participant will be expected to abide strictly by Riverbend Combat Association rules, and that any infraction of these rules may result in an immediate end to his/her participation in Riverbend Combat Association activities, without refund of any dues paid. I/We agree to pay for Participant's return transportation from Riverbend Combat Association if he/she is precluded from participation.

I/We grant permission to Riverbend Combat Association personnel to arrange for medical attention of the minor Participant listed on this form in case of an emergency.

Parent(s)/Guardian(s) signature _____________________________________________________

Parent(s)/Guardian(s) printed __________________________________________________

Date ____/____/_____

Emergency # ____________________________

Notary Signature__________________________________________

Date notarized _____________________ Expiration of Commission_________________________

State & County of Notary________________________

Please list any allergies (food, medical, etc.) or medical conditions. __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________