Athletic Clearance"*" indicates required fieldsStep 1 of 714%Which team are you on?*MTI Prep- Pompano Beach, FloridaMTI Prep- Gainesville, FloridaParticipant Name* First Last Participant Age*Participant Phone Number*Participant Email* Sickle Cell Trait Waiver* I agree to the Sickle Cell Trait WaiverSICKLE CELL TRAIT WAIVER Sickle Cell Trait is an inherited condition of the oxygen-carrying protein, hemoglobin, in the red blood cells. • Sickle Cell Trait is a common condition (> three million Americans). • Although Sickle Cell Trait is most predominant in African-Americans and those of Mediterranean, Middle Eastern, Indian, Caribbean, and South and Central American ancestry, persons of all races and ancestry may test positive. • An undiagnosed trait can be dangerous, even fatal. During intense, sustained exercise, hypoxia (lack of oxygen) in the muscles may cause sickling of red blood cells (red blood cells changing from a normal disc shape to a crescent or “sickle” shape), which can accumulate in the bloodstream and block blood vessels, leading to collapse from the rapid breakdown of muscles starved of blood and possible death. • Over twenty college football players with Sickle Cell Trait have collapsed and died over the past decade. • Heat, dehydration, altitude and asthma can increase the risk for and worsen complications associated with Sickle Cell Trait, even when exercise is not intense. • If an athlete tests positive, he or she will still be able to participate in athletic activities with certain precautions. • More information on Sickle Cell Trait may be found at the following NCAA website: www.NCAA.org/health-safety McDougle Technical Institute Preparatory mandates student-athletes be tested for Sickle Cell Trait, show proof of a prior test, or sign a waiver releasing the school from liability if they decline to be tested before participating in athletic-related activities, including athletic events, strength and conditioning sessions, practices, competitions, etc. I acknowledge that I have read the above information and I understand that an undiagnosed trait can be dangerous, even fatal, and agree to sign the waiver below. I understand and acknowledge that McDougle Technical Institute Preparatory mandates that all student-athletes are tested for Sickle Cell Trait, show proof of a prior test, or sign a waiver releasing the school from liability if they decline to be tested before participating in athletic-related activities. Recognizing that my true physical condition is dependent upon an accurate medical history and a full disclosure of any symptoms, complaints, prior injuries, ailments, and/or other disabilities experienced. I hereby affirm that I have fully disclosed in writing any knowledge of Sickle Cell Trait status to McDougle Technical Institute Preparatory. I do not wish to undergo sickle cell testing as part of my pre-participation physical exam and I voluntarily agree to release, discharge, indemnify and hold harmless McDougle Technical Institute Preparatory, their respective owners, coaches, associated medical staff, instructors, agents volunteers, sponsors or employees from any and all costs, liabilities, expenses, claims, demands, or causes of action on account of any loss or personal injury that might result from my voluntary decision not to be tested. I, the undersigned, have read this release and understand its terms. I execute it voluntarily and with full knowledge of its significance.Waiver of Liability and Release* I agree to the Waiver of Liability and ReleaseFor and in consideration of the undersigned participant's registration with the McDougle Technical Institute Preparatory ("Organization") and being allowed to participate in events and member activities, participant and the parent(s) or legal guardian(s) of participant (if Participant is under 18) waive, release and relinquish any and all claims for liability and cause(s) of action, including for personal injury, property damage or wrongful death occurring to participant or participant’s parent(s) or legal guardian(s) arising out of participation in events, or sports, and/or activities incidental thereto, whenever or however they occur and for such period said activities may continue, and by this agreement any such claims, rights, and causes of action that participant and/or participant's parent(s) or legal guardian(s) may have are hereby waived, released and relinquished, and participant and participant’s parent(s)/guardian(s) do so on behalf of their heirs, executors, administrators and assigns. Participant and participant's parent(s)/guardian(s) acknowledge, understand and assume all risks relating to events or sports participation and activities incidental thereto, and understand that activities incidental thereto involve risks to participant's and participant's parent('s)/ guardian('s) person including bodily injury, partial or total disability, paralysis and death, and damages which may arise there from and that they have full knowledge of said risks. These risks and dangers may be caused by the negligence of the participant, participant's parent(s)/ guardian(s)or the negligence of others, including the Organization, its affiliates, members, event hosts, other participants, other parents and legal guardians, coaches, officials, sponsors, advertisers, owners and operators of the premises used to conduct any event and each of them, their officers, directors, agents and employees (collectively, "releasees"), and include risks arising from the conditions and use of facilities and related premises. I/We further acknowledge that there may be risks and dangers not known to us or not reasonably foreseeable at this time. Participant and participant's parent(s)/guardian(s) acknowledge, understand and assume the risks, if any, arising from the conditions and use of facilities and related premises, whether as a participant or a spectator, including without limitation, the risks involved with participating in the Organization’s activities. Participant and participant's parent(s)/guardian(s) further acknowledge and understand that included within the scope of this waiver and release is any cause of action (including any cause of action based on negligence) arising from the performance, or failure to perform, maintenance, inspection, supervision or control of said areas and for the failure to warn of dangerous conditions existing at said facilities, for negligent selection of certain releasees, or negligent supervision or instruction by releasees. Participant and participant's parent(s)/guardian(s) acknowledge and understand that the Organization reserves the right to photograph facilities, activities and program participants for potential future use. All photos remain the property of the Organization and may be used for promotional services. Participant and participant's parent(s)/guardian(s) grant permission for the Organization to publish, copyright, or use all films, photographs, computer- generated imagery, and printed and spoken words in which participant is included, whether taken by staff, volunteers, participant's, or others. Participant and participant's parent(s)/guardian(s) further agree that the Organization can use these photographs, films and words for any exhibitions, displays, web pages and publications, without reservation or compensation. Consent to Medical Treatment: Participant and participant’s parent(s)/guardian(s) hereby give consent to have the participant treated by a physician or surgeon in case of sudden illness or injury while participating in the above event. It is understood that the Organization provides no medical insurance for such treatment under its liability insurance coverage. The location of the activity or the nature of the illness or injury may require the use of emergency medical personnel. Participant and participant's parent(s)/guardian(s) agree if any claim for personal injury or wrongful death is commenced against releasees, he/she shall defend, indemnify and save harmless releasees from any and all claims or causes of action by whomever or wherever made or presented for his/her personal injuries, property damage or wrongful death. Participant and participant’s parents/ guardian agree that the Waiver of Liability and Release is intended to be as broad and inclusive as permitted by applicable law and that if any portion is held invalid, all remaining portions will continue in full force and effect. Participant and participant's parent(s)/guardian(s) acknowledge that they have been provided and have read the above paragraphs and have not relied upon any representations of releasees, that they are fully advised of the potential dangers and risks and understand these waivers and releases are necessary to allow the activities of the Organization to exist in its present form.Assumption of Risk and Waiver of Liability Relating to Coronavirus/COVID-19* I agree to the Assumption of Risk and Waiver of Liability Relating to Coronavirus/COVID-19The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend physical distancing and have, in many locations, prohibited the congregation of groups and people. McDougle Technical Institute Preparatory (Organization) has put in place preventative measures to reduce the spread of COVID-19; however, the Organization cannot guarantee that you, or any other person, will not become infected with COVID-19. Further, participating in programs at McDougle Technical Institute Preparatory could increase your risk of contracting COVID-19. Therefore, if you choose to participate you are required to acknowledge and execute this Waiver. ACKNOWLEDGEMENT By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by participating in programs at McDougle Technical Institute Preparatory 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 Organization activities may result from the actions, omissions, or negligence of myself and others, including but not limited to McDougle Technical Institute Preparatory employees, volunteers, vendors, sponsors and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury myself, including, but not limited to, personal injury, disability, death, illness, damage, loss, claim, liability, or expense or any kind, that I may experience or incur in connection with my attendance at McDougle Technical Institute Preparatory activities or programming. On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless and indemnify the McDougle Technical Institute Preparatory , its officials, employees, agents, sponsors, vendors and representatives, of and from any and all 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 the McDougle Technical Institute Preparatory, its employees, agents and representatives, whether a COVID-19 infection occurs before, during, or after participation in any McDougle Technical Institute Preparatory program.McDougle Technical Institute Preparatory Housing Agreement* I agree to the McDougle Technical Institute Preparatory Housing AgreementBackground A. School operates a Student residence dormitory in order to provide on-campus housing to enrolled Students during specified times of the academic year. B. Student is a prospective or enrolled Student that either intends to enroll or remain enrolled in the School for the duration of the term of this Agreement. C. Student has previously submitted an application to School expressing a desire to occupy and utilize an assigned space in one of the School's dormitories, and Student understands that the School shall assign the particular facility and room (the "Space") subsequent to Student's execution of this Agreement. D. Student is required to execute this Agreement in order to secure a Space, and School and Student enter into this legally binding Agreement to set forth the terms and conditions of their agreement governing Student's occupancy and use of the Space. E. For purposes of this Agreement, “Student” includes those students enrolled in a postsecondary institution of higher education with which the School has an affiliation agreement to provide residential student housing services. In consideration of the mutual promises and covenants contained herein, Student agrees to abide by the written mandatory housing guidelines provided and the payment terms. Effective Date This Agreement becomes effective and enforceable immediately upon the Effective Date, which is the date the Student signs this Agreement. However, Student is not assured of an assigned Space unless and until Student has paid to the School the required prepaid rent in accordance with this Agreement, or School has recognized such payment as deferred. Grant of Use In exchange for Student’s payments to School in accordance with this Agreement, and subject to all of its terms, conditions, and restrictions, School grants conditional authorization to Student to occupy and use the Space, to be determined and assigned to Student within the School’s sole discretion. Student must be enrolled in the School or in a postsecondary institution of higher education with which the School has an affiliation agreement to provide residential student housing services in order to be eligible for, or to remain in, School housing. Student’s occupancy of the Space shall officially begin when the Student signs in to his/her assigned Space. Payment Entering into this Agreement legally obligates Student or if Student is under age 18, the Student’s parent or guardian to make payment to the School for the assigned Space, regardless of any Student-indicated preferences concerning a specific room type, location, or roommate. School's assignment of a Space to Student, and Student’s continued occupancy of a Space, are contingent upon Student’s final admission to the School and timely payment of all charges and fees to School, including those due under this Agreement. The School (or the School’s designee), in its sole and absolute discretion, may cancel this Agreement or change Student’s Space assignment in the interest of order, discipline, health, safety, security, maximum utilization of Schools facilities and resources, and/or educational delivery, or for the Student’s failure to pay rent or charges in a timely manner. The housing fee is non-refundable. If a Student moves out early, the cost will remain the same. No prorations or refunds will be allowed. The only extra cost to this agreement will be if a Student exceeds the allotted time to complete his/her educational program. In this case, McDougle Technical Institute Preparatory will charge on a month by month basis for the remainder of the Student’s stay. There is a $250.00 deposit for breakage, damage or misuse of dorm facility. By Signing this Application, Student is reserving a place and agrees to abide by the written mandatory housing guidelines provided to Student and the payment terms.MTI Prep Pre-participation PhysicalDo you have a MTI Prep Pre-participation Physical Form signed and dated by all parties, including a licensed physician.*YesNoA MTI Prep Pre-participation Physical Form signed and dated by all parties, including a licensed physician is required to receive clearance to participate.Do you understand and accept the risks associated with playing in tackle football?*YesNoHave you been cleared by a licensed physician to play tackle football?*YesNoDo you have any medical conditions that we should be aware of?*NoYesPlease explain*Do you have health insurance coverage?*YesNoI am unsureMedical insurance is MANDATORY for all student athletes. If you do not have insurance contact support@mti.eduHealth Insurance CoverageMedical insurance is MANDATORY for all student athletes. If you do not have insurance contact support@mti.eduName of Health Insurance Company*Policyholders Name*Relationship to Policyholder*SelfDependentSpouseOtherPolicy Group NumberPolicy Number*Family Educational Rights and Privacy Act (FERPA)*The Family Educational Rights and Privacy Act (FERPA) is a federal law that affords parents the right to access their children’s education records, the right to seek to have the records amended, and the right to have some control over the disclosure of personally identifiable information from the education records. When a student turns 18 years old, or enters a postsecondary institution at any age, the rights under FERPA transfer from the parents to the student. I consent to the release of my records to my parent(s) or guardian(s) listed below for the purpose of keeping them informed about my enrollment at McDougle Technical Institute Preparatory. I understand that education records include, but are not limited to, information about my academic standing, disciplinary issues and financial obligations to the Institute. I acknowledge that I may submit a subsequent notification in writing directing the Institute to no longer release information to any or all of the individuals listed below. McDougle Technical Institute Preparatory is authorized to release information to the following individuals (please print clearly): I do not consent to the release of my education records to my parent(s) or guardian(s).Parent/Guardian Name* First Last Parent/Guardian Phone*Parent/Guardian Email* Is your Parent/Guardian your Emergency Contact?YesNoEmergency ContactEmergency Contact Name* First Last Relationship to Participant*ParentFamily MemberFriendOtherEmergency Contact Phone*Emergency Contact Email* Participant ConsentParticipant Electronic Signature* I agree to the Electronic Signature policy.Electronic Signatures. If this Agreement has been signed with an electronic signature the parties hereto consent and agree to the use of such electronic signature with respect to this Agreement pursuant to the Electronic Commerce Act 2000, S.O. 2000, c17 as amended from time to time.Upload a copy of your government issued ID (proof of age)* Drop files here or Select filesMax. file size: 256 MB. Parent/Guardian Consent (if participant is under 18)*Parent/Guardian Electronic Signature (if participant is under 18)* I agree to the Electronic Signature policy.Electronic Signatures. If this Agreement has been signed with an electronic signature the parties hereto consent and agree to the use of such electronic signature with respect to this Agreement pursuant to the Electronic Commerce Act 2000, S.O. 2000, c17 as amended from time to time.Upload a copy of Parent/Guardian government issued ID* Drop files here or Select filesMax. file size: 256 MB. Δ