REGIONAL MENTAL-GAME CLINIC INFORMATION FORM - Please be sure to register and pay for the clinic. This form alone does not constitute registration.

Athlete Name *
Athlete Name
Regional Clinic You are Attending *
Address *
Athlete Cell Phone *
Athlete Cell Phone
Birthday *
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
Guardian Medical Consent *
I, as the Parent/Guardian, authorize the coaches of Ready Set Row to make decisions to proceed with any medical care and/or emergency medical treatment deemed necessary, provided that reasonable attempts to contact me, or any other contacts listed, have been made. I will be responsible for all costs associated with the medical care or emergency medical treatment. The coaches have my permission to give over-the-counter medications (e.g. Ibuprofen, Tylenol) stocked in the medical training kit. By checking this box, I hereby consent to allow the physician(s) and other health care provider(s) to provide treatment for any injury received while participating in or training for Ready Set Row. I further consent to allow physician(s) or health care provider(s) to share appropriate information concerning my child that is relevant to participation, with coaches, medical staff, and other personnel as deemed necessary.
Athlete/Guardian Photography/Video Release *
I as the Parent/Guardian have read and agree to: Participants involved in any activities offered by Ready Set Row may be photographed, interviewed, or videotaped during training and camp. We hereby consent to the use of these photographs, interviews, and/or videos without compensation, on the Ready Set Row website or in any editorial, promotional or advertising material produced and/or published about Ready Set Row or BRAVE Enterprises.
Guardian RSR Documents *
I as the Parent/Guardian certify that both the Athlete and a Parent/Guardian have both read and understand the following RSR Documents: RSR Athlete Commitment Form and RSR Concussion Form as listed on the RSR website. I agree to have a full physical for my athlete within 12 months of the start date of the RSR program and will send that physical form with physician signature to RSR or the Host of the Clinic.
RSR Refund Policy *
Ready Set Row Refund Policy There are no refunds for Mental-Game Clinics. Regional Clinic participants pay the full $100 to register and there are no refunds.
Guardian Consent - Rules, Participation, Health *
I, as the Parent/Guardian consent to the Athlete attending and participating in all of the activities associated with the RSR Camp, Clinic or Training Program which will include physical, mental and emotional training. I understand that if my athlete breaks any RSR Rule I may receive a phone call from a Coach at any time of day or night (and for overnight programs) depending on the offense, may be required to pick up my child within 24 hours if she is expelled with no refunds.
Guardian Waiver and Release of Liability *
Waiver and Release of Liability for Parent/Guardian Express assumption of risk: I, the undersigned, am aware that there are significant risks involved in all aspects of physical training and in taking part in the Ready Set Row training. I fully understand that: (a) ROWING, PHYSICAL TRAINING ACTIVITIES and COMPETITIONS INVOLVE RISKS AND DANGERS of serious bodily injury, including permanent disability, paralysis and death (“Risks”); (b.) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, improper use or failure of equipment, or the negligence of the Releasees named below; (c.) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, EXPENSES, COSTS, AND DAMAGES I incur as a result of my participation in the Rowing Activity or class while at, or under the direction of Ready Set Row or the Host of the Clinic. I acknowledge that I have no physical or mental impairments, injuries, or illnesses that will endanger me or others. Release: In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities offered by Ready Set Row, I, the undersigned hereby release Ready Set Row and the Host of the Clinic, their principals, agents, employees, guests and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties. This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. If I am signing on behalf of a minor child, I also give full permission for any person connected with Ready Set Row to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the Athlete. Indemnification: The participant recognizes that there is risk involved in the types of activities offered by Ready Set Row. Therefore the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant. The participant also accepts full financial responsibility for any property damage to the Host of the Clinic or equipment damage from the Host of the Clinic or Ready Set Row due to participant’s gross negligence and/or willful or dishonest acts. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless Ready Set Row and the Host of the Clinic, their principals, agents, employees, guests and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by Ready Set Row or at/near the Host of the Clinic. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to main building, and/or any area selected for training or travel by Ready Set Row. I have read and understood the foregoing assumption of risk, and release of liability and I understand that by my signature below, I am obligated to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.