* Required Fields
Parents will be notified first in the event of an emergency. In case parents cannot be reached, please list two additional emergency contacts:
There is an inherent risk of injury in the us of or presence in Great Lakes Athletic Club, the use of it's equipment and services and participation in its programs, whether such participation occurs at the facility or in supervised or unsupervised activities sponsored or endorsed by GLAC outside of the facility. I understand and fully accept this risk for myself or on behalf of my minor child and shall hold this club, its shareholders, directors, officers, employers, representatives and agents harmless from any loss, claim, injury, damage or liability sustained or incurred by me or my minor child resulting there from. In the event of an emergency I give my permission to Great Lakes Athletic Club to secure all necessary and required medical treatment for the above named participant.
In consideration of the value received, receipt whereof is acknowledged, I hereby give Great Lakes Athletic Club the absolute right and permission to copyright and/or publish, use or photographic portraits or pictures of me or my minor child. These images may be used in whole or in part or composite or distorted in character or form, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise, made through any media at their studios or elsewhere for art advertising, trade, or any lawful purpose whatsoever.
I hereby waive any right that I may have to inspect and/or approve the finished product or the advertising copy that may be used in connection therewith, or the use to which it may be applied.
I hereby release, discharge and agree to save Great Lakes Athletic Club from any liability that may occur or be produced in the taking of said pictures or in the processing tending towards the completion of the finished product.