Athlete Information (Athlete 1):
First and Last Name:
Gender: (Male/Female) —Please choose an option— Male Female
Date of Birth
DAY —Please choose an option— 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
MONTH —Please choose an option— Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Season: —Please choose an option— Indoor Outdoor Indoor & Outdoor
Region: —Please choose an option— Durham Peel Clarington Scarborough/Markham
School Grade: —Please choose an option— 1 2 3 4 5 6 7 8 9 10 11 12
Cell Phone & Email (Optional):
Athlete Information (Athlete 2):
First and Last Name:
Gender: (Male/Female) —Please choose an option— Male Female
Date of Birth
DAY —Please choose an option— 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
MONTH —Please choose an option— Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Season: —Please choose an option— Indoor Outdoor Indoor & Outdoor
Region: —Please choose an option— Durham Peel Clarington Scarborough/Markham
School Grade: —Please choose an option— 1 2 3 4 5 6 7 8 9 10 11 12
Cell Phone & Email (Optional):
Athlete Information (Athlete 3):
First and Last Name:
Gender: (Male/Female) —Please choose an option— Male Female
Date of Birth
DAY —Please choose an option— 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
MONTH —Please choose an option— Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Season: —Please choose an option— Indoor Outdoor Indoor & Outdoor
Region: —Please choose an option— Durham Peel Clarington Scarborough/Markham
School Grade: —Please choose an option— 1 2 3 4 5 6 7 8 9 10 11 12
Cell Phone & Email (Optional):
Athlete Information (Athlete 4):
First and Last Name:
Gender: (Male/Female) —Please choose an option— Male Female
Date of Birth
DAY —Please choose an option— 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
MONTH —Please choose an option— Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Season: —Please choose an option— Indoor Outdoor Indoor & Outdoor
Region: —Please choose an option— Durham Peel Clarington Scarborough/Markham
School Grade: —Please choose an option— 1 2 3 4 5 6 7 8 9 10 11 12
Cell Phone & Email (Optional):
Waiver Release and Indemnity
IN CONSIDERATION of the acceptance of my application and the permission to participate as an entrant of membership, practice, competition, or any other event as part of The Gazelles T & F Club, during the season for which I am registered, I, for myself, my heirs, executors, administrators, successors and assigns HEREBY RELEASE, WAIVE AND FOREVER DISCHARGE The
The Gazelles Track and Field Club Athletics Ontario, Minor Track Association (MTA) and all other associations, sanctioning bodies and sponsoring companies, and all other agents, officials, servants, contractors, representatives, successors and assigns OF AND FROM ANY AND ALL CLAIMS, demands, damages, costs, expenses, actions and causes of actions, where in law or equity, in respect of death, injury, loss or damage to my person or property, HOWEVER CAUSED arising or to arise by reason of my participation in said, whether as a spectator, participant, competitor or otherwise; whether prior to, during or subsequent to any such event and NOTHWITHSTANDING that some may have contributed to or occasioned by the negligence of any of the aforesaid. I FURTHER UNDERTAKE TO HOLD AND SAVE HARMLESS AND AGREE TO
INDEMNIFY all of the aforesaid from and against any and all liability incurred by any or all of them arising as a result of, or in any way connected with my participation in the said event. By submitting this entry, I acknowledge having read, understood and agreed to the above waiver, release and indemnity. I warrant that I am physically fit to participate as a member of The Gazelles Track and Field Club .
Release Form for Media Recording
I, the undersigned, do hereby consent and agree that The Gazelles Track and Field Club, its employees, or agents have the right to take photographs, videotape, or digital recordings of me while training and to use these in any and all media, now or hereafter known, and exclusively for the purpose of a video and/or picture displaying activities, training, coaching, mentoring and testimonials. I further consent that my name and identity may be revealed therein or by descriptive text or commentary.
I do hereby release to The Gazelles Track and Field Club, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately and to market. I waive any rights, claims, or interest I may have to control the use of my identity or likeness in whatever media used.
I understand that there will be no financial or other remuneration for recording me, either for initial or subsequent transmission or playback.
I also understand that The Gazelles Track and Field Club, is not responsible for any expense or liability incurred as a result of my participation in this recording, including medical expenses due to any sickness or injury incurred as a result.
POWER OF ATTORNEY for use in 2022/2023:
(The Power of Attorney is used to allow you, the Donor (either athlete or parent/guardian of athlete), to appoint a representative to be your attorney and to sign Athletics Ontario & Minor Track Association entry forms, waivers etc. on your behalf)
I appoint all or any Staff and/or Gazelle Coach of The Gazelles Track and Field Club, jointly and severally, to be my attorney(s) in accordance with the Powers of Attorney Act and to do on my behalf anything that I can lawfully do by an Attorney.
This power of attorney is subject to the following conditions and restrictions: This Power of Attorney shall only apply to enable my said attorney(s) to execute such entry forms, waivers and other documents as may be required to permit me or the Athlete named above to participate in any event sponsored or sanctioned by Athletics Ontario & Minor Track Association during the 2022/2023 calendar years commencing September 20th, 2022 and ending on September 18th 2023.
I hereby acknowledge that by signing such entry forms, waivers and other documents that my attorney(s) may WAIVE ANY AND ALL CLAIMS that I, the Athlete Named Above, my heirs, executors, administrators, successors and assigns may have against The Gazelles T & F Club, Athletics Ontario & Minor Track Association and its respective agents, officials, employees, contractors, representatives, successors and assigns with regard to ANY demands, damages, costs, expenses, actions and causes of action, whether in law or equity, in respect of death, injury, loss or damage to my person or property HOWSOEVER CAUSED arising or to arise by reason of my participation or the participation of the Athlete Named Above in any Gazelles Track &, Athletics Ontario & Minor Track Association sponsored or sanctioned event in the said 2022/2023 calendar years, whether prior to, during or subsequent to any such event and NOTWITHSTANDING that same may have been contributed to or occasioned by the NEGLIGENCE of any of the aforesaid.
I represent that I am at least 18 years of age, have read and understand the foregoing statements of Waiver, Media Releases and Power of Attorney above and am competent to execute this agreement. I am the parent and/or legal guardian of the child being filmed and understand the foregoing statements of Waiver, Media Releases and Power of Attorney above, and am competent to execute this agreement