MAQ 2024 Summer Train and Play Registration

Please fill out all of the fields below to register. NOTE: Registration is not complete until payment is made by check, credit card, or PayPal.

"*" indicates required fields

Athlete Name*
Address*
Gender*
Birth Date*
Summer Program*

Emergency Contact

Name*
Self/Guardian/Primary Contact/Physicians Release*
(THE ABOVE CHECKBOXES MUST BE CHECKED AND WILL BE VERIFIED.) I hereby state that Maq and Dschierbaum LLC is not responsible for any pre-existing injury or recurrence of any undisclosed pre-existing injury or illness of the above participant. Maq and Dschierbaum LLC will only assume responsibility for injuries incurred while the above participant is participating in activities under supervision during enrolled period, up to the limits of the facility and organizations insurance coverage. I acknowledge that there are natural hazards associated with training and working out as well as related activities indoor and outdoor settings. I hereby affirm that I/and or my child is in good health and physically capable of performing the required activities of this training regime. In consideration of Maq and DschierbaumLLC accepting me/or my child and to the extent permitted and provided and provided by state law, I hereby release and forever discharge Maq/Dschierbaum LLC, its unit, agents and employees from all claim of liability for any damages injuries which may be sustained while I am/or my child is at training. The law requires that personal permission be obtained for medical treatment of minors. The following content form should be signed by the parent so that such procedures may be promptly carried out, and so that no unnecessary delays will occur with treatment. However, no operation will be performed, except emergency without parent’s being contacted and fully informed. I give permission of such diagnostic, therapeutic, and operative procedures as deemed necessary.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending MAQ and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, MAQ employees, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at MAQ or participation in MAQ programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Club, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of MAQ, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any program at MAQ or subsidiary facilities.

I understand the hazards of the novel coronavirus (“COVID-19”) and am familiar with the Centers for Disease Control and Prevention (“CDC”) guidelines regarding COVID-19. I acknowledge and understand that that the circumstances regarding COVID-19 are changing from day to day and that, accordingly, the CDC guidelines are regularly modified and updated and I accept full responsibility for familiarizing myself with the most recent updates.

2. Notwithstanding the risks associated with COVID-19, which I readily acknowledge, I hereby willingly choose to participate in Activities at MAQ. This entire consent is to cover all MAQ facilities, home facility and any place of work where any member of MAQ staff operates.

I understand that by completing this registration I am responsible for 8 or 16 sessions in Full regardless of whether or not sessions are used by September 1st, 2024*
Please type FULL NAME and DATE.
Credit Card on File*
Credit card on file will only be charged if invoice is not paid by cash or check. Every athlete must have a valid credit card on file. All credit card charges incur a 3% fee.