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Release of Liability and Assumption of Risk:
In consideration of my child named above being allowed to participate in Platinum Athletics Prep Academy LLC and Orange Vista High School (listed above), the undersigned(s), being the lawful parent(s) and/or guardians of the above named minor, for myself, spouse and my child/ward knowingly and freely assume all risks, both known and unknown and assume full responsibility for my child/ward’s participation. I hereby authorize the coaches for Platinum Athletics Prep Academy LLC and Orange Vista High School to act for me in any emergency requiring medical attention for my child (listed above). I hereby release, hold harmless and agree to indemnify and defend Platinum Athletics Prep Academy LLC and Orange Vista High School and its affiliated volunteers and coaches from any and all liabilities with respect to any and all injury, disability, death, incident to my child/ward’s involvement or participation in the activities above. I hereby certify that all the information provided is accurate and that I have read the Release of Liability and Assumption of Risk statement above and fully understand its terms and by signing this form I have given up substantial rights and I sign this form freely and voluntarily without any inducement.

Parent/Guardian Signature

HOME LOCATION: 13373 PERRIS BLVD STE B113 MORENO VALLEY, CA 92553

951-229-5694 OR 562-212-6634

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