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Capital of Texas Heat Track Club | ||||||||||||||||||||||||||||
| Post Office Box 15665 | |||||||||||||||||||||||||||||
| Austin, Texas 78761-5665 | |||||||||||||||||||||||||||||
| (512) 929 7273 | |||||||||||||||||||||||||||||
| Statement of Liability Release | |||||||||||||||||||||||||||||
| Mission Statement: To offer lifelong progress of amateur athletics track and field competition for youth of all ages, races and creed, to enhance the physical, mental and moral development to promote good sportsmanship, good citizenship and safety, to utilize these skills to pursue secondary education and become resourceful citizens in their community. | |||||||||||||||||||||||||||||
| Back to Registration Home Page | |||||||||||||||||||||||||||||
| I, _________________________________ will not hold the Capital of Texas Heat, Inc., Leslie Riggins, Head Coach, or any of the coaching staff members of the Capital of Texas Heat, Inc., responsible for any accident or injury to my child, ______________________________________, while he/she is under their supervision during practices, competition, and/or fundraising activities. I, thereby, for myself, my heirs, assigns, and executors waive and release any and all rights and claims for damages, that I, my heirs, assigns and executors may have against the Capital of Texas Heat, Inc., its coaching staff, and volunteers and their respective representatives for any and all injuries which may be suffered in connection with any participation with/in Capital of Texas Heat, Inc., during practices, competition, and/or fundraising activities. |
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| Signature:_________________________________________ | |||||||||||||||||||||||||||||
| Parent: ___________________________________________ | |||||||||||||||||||||||||||||
| SUBSCRIBED AND SWORN TO BEFORE ME by said affiant on this, | |||||||||||||||||||||||||||||
| the ________ day of ___________________, 20________, to certify | |||||||||||||||||||||||||||||
| which witness my hand and official seal. | |||||||||||||||||||||||||||||
| ____________________________ | |||||||||||||||||||||||||||||
| Notary Public, State of Texas | |||||||||||||||||||||||||||||
| ____________________________ | |||||||||||||||||||||||||||||
| Notary's Name Printed | |||||||||||||||||||||||||||||
| ____________________________ | |||||||||||||||||||||||||||||
| Commission Expires (Date) | |||||||||||||||||||||||||||||