POLE VAULT ACADEMY
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POLE VAULT ACADEMY
​Southern Nazarene University


                                                                          POLE VAULT ACADEMY WAIVER

I, the parent or legal guardian do hereby grant permission for myself/my child to attend the POLE VAULT ACADEMY sessions and meets at the Pole Vault Academy training facility at the Sawyer Center on the campus of Southern Nazarene University in Bethany, OK. I do herby waive and release ANY and ALL Rights and Claims for damages due to injury and death that may be suffered before, during and after the camp, practice or meet event. I AGREE to indemnify, hold harmless, and defend all liability charges or accusations against the POLE VAULT ACADEMY, Mark Heard, Southern Nazarene University and any Coaches, Sponsors, or Agents connected to the  POLE VAULT ACADEMY pole vaulting camps, practices or meets. I FULLY UNDERSTAND the act of pole vaulting is potentially dangerous by its nature and that possible injury could occur during the course of instruction. Warning: Sports by their very nature pose the continuous treat of injury which NO TYPE of EQUIPMENT can ensure against or prevent. ANY PERSON NOT WILLING to ASSUME and BE RESPONSIBLE FOR THE CONSEQUENCES OF INJURY SHOULD NOT PARTICIPATE. The wearing of EQUIPMENT such as helmets, pads, or other such devices, MAY HELP TO REDUCE THE RISK OF INJURY, BUT WILL NOT PREVENT IT. I verify that myself/my child has had a physical examination in the last twelve (12) months prior to the participation at the  POLE VAULT ACADEMY at SNU and has been certified by a certified physician to be eligible to participate in the pole vaulting practices, camps, meets and any related training activity. Should a MEDICAL EMERGENCY arise and I (the parent or legal guardian) CANNOT BE REACHED (after every reasonable attempt is made to contact me, I hereby authorize any certified physician, nurse or trainer selected by the  POLE VAULT ACADEMY personnel to order and conduct any medical or surgical procedures necessary for the welfare and betterment of myself/my child. By my signature, I ATTEST TO UNDERSTAND this WAIVER in it’s ENTIRETY and hereby declares this for my heirs, my executors, and myself.  In addition, I grant POLE VAULT ACADEMY the right to use any videos or photographs of myself/my child in training related activities for the purpose of advertising or coaching/educational productions.​​ 

    I HAVE READ THE WAIVER AND AGREE TO THE TERMS

Submit

    Emergency Contact Information

    Please Include 2 Emergency Contact Phone Numbers.
    Please Include 2 Emergency Contact Phone Numbers.
Submit

Print and complete the SNU Release, bring with you to the first session.
general_snu_participant_waiver.pdf
File Size: 930 kb
File Type: pdf
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  • PVA Home
  • PVA Director
  • REQUIRED FORMS
  • Camp Dates & Price
    • 2023 Summer Series
  • Pictures
  • Pole Rental