HALO Athletics
South County Campus Homeschooling Class
Registration, Parental Waiver, Release of Liability,
Indemnification Consent and Participation Form
I, the undersigned, as the parent or legal guardian of the child named below, do hereby give my full
consent and approval for my child to participate in Physical Education classes provided through the
Homeschooled Athletic League Organization, DBA HALO Athletics (“HALO”).
I understand that there are certain risks of damages and injuries, including death, inherent in the
practice and play of athletic activities, as well as, in other related activities incidental to my child’s
participation in physical education classes, and I am willing to assume these risks on behalf of my child.
These risks include, but are not limited to, those hazards associated with weather conditions, playing
conditions, equipment and other participants.
I understand that the very nature of participating in physical education activities is hazardous and risky,
including, but not limited to, the acts of pitching a ball, kicking a ball, being hit by a ball, running,
jumping, stretching, sliding, collisions with other players, volunteers and stationary objects, all of which
can cause serious injury or death to my child and to other participants.
Further, I agree that in consideration for the right to allow my child to participate in physical education
classes and in consideration for permission to play on the fields/parks arranged for by “HALO”:
1. On behalf of my child and myself, I do voluntarily elect to accept and solely assume all risks of
injury incurred or suffered by my child (a) while practicing or playing as a member of the class
so designated, (b) while serving in a non-playing capacity as a class member or observer during
class, and (c) while on or upon the premises of any and all of the fields/parks arranged for by
“HALO” class and/or play.
2. In addition to giving my full consent for my child’s participation, I do hereby waive, release,
discharge and agree not to sue “HALO”, its agents, instructors, contractors, the owner or
operator of any field/park, or any person or entity connected with the class or “HALO” or
field/park for any claim, damages, costs including attorneys fees, or cause of action which I or
my child have or may have in the future as a result of damages, injuries, including death,
sustained or incurred by my child from whatever cause including, but not limited to, the
negligence, breach of contract or wrongful conduct of the parties hereby released.
I hereby certify that my child is fully capable of participating in classes provided by “HALO” and that my
child is healthy and has no physical or mental disabilities or infirmities that would restrict full
participation in these activities, except as made known to coaches and officials of “HALO”.
I further agree on behalf of myself and my child listed below, that I shall hold harmless and fully
indemnify the parties hereby released from any and all claims, damages, costs including attorney fees,
and causes of action which may arise from any cause of action made by me or by, through or on behalf
of my child, even if the damages, injuries or death are caused in whole or in part by any of the persons
or entities herby released.
In the event of an emergency, I authorize “HALO” to secure from any licensed hospital, physician
and/or medical personnel whatever treatment is deemed necessary for my minor child’s/ward’s
immediate care and agree that I will be responsible for payment of any and all medical services
rendered.
I hereby grant full permission for the free use of name and/or photographs, videotapes and/or other
record taking during “HALO” classes for any legitimate purpose and waive all claims for compensation.
Homeschooled Athletic League Organization, a Non-Profit Corporation
Phone: (949) 351-9442
Initial Here ___________
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I acknowledge that all fees are payable in advance of my child’s attendance in class and that my
child can be refused attendance if fees or other payment arrangements have not been made in
advance of each class/trimester of classes. I voluntarily execute this agreement and further
acknowledge; (a) that I have read (or have had read to me) each and every one of the provisions
in this waiver, release of liability and indemnification agreement, (b) that I understand each of
the provisions in this agreement and (c) that I agree to abide by them.
STUDENT REGISTRATION
A Registration Fee of $50.00 per semester is due upon registering. This deposit is nonrefundable and will be deducted from the donation balance for the semester. Please make your
Registration check payable to HALO Athletics, attach it to this completed Parental Waiver and
Registration Form and mail it to HALO Athletics, Attn: Dave Scott, 45 Ridgecrest, Aliso Viejo,
CA 92656.
Note: Class donation fee for the first semester class is a total of $160.00. Donation balance is
$110.00. Class donation fee for the second semester class is a total of $140.00. Donation
balance is $90.00.
First Semester Registration
Second Semester Registration
Student Name:
_____________________________ Birth date: _________ Age: ____
Medical Issues:
________________________________ _____Grade: ____________
Address:
___________________________________________________
City: ______________________________ Zip: _____________
Home Phone: (_______) ____________ Work Phone: (_______) ______________
Cell Phone:
(_______) ____________
_____________________________________
E-mail Address
Child is enrolled in the ______________________________________ Charter School
_______________________________________________ Date signed _______________
Name of parent or legal guardian (Please print)
X ______________________________________
Signature of parent or legal guardian
“HALO Athletics” Administration Only:
Date received by the “HALO” Secretary ______________
Payment Information: Charter School ________ Cash ________ Check/MO ________
Comments:
Homeschooled Athletic League Organization, a Non-Profit Corporation
Phone: (949) 351-9442
Initial Here ___________
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