Name *

First Name

Last Name

Phone

(###)

###

####

Stunt Position *

Flyer

Main Base

Side Base

Backspot

None

Tumbling *

(select all that apply)

Standing Backhandspring

Running Backhandspring

Standing Back Tuck

Running Back Tuck

Back Layout

Full

Specialty Pass to Full

None

Consent Form *

BLOODLINE SPORTS: WEBSITE, SOCIAL MEDIA, VIDEO, AND INTERVIEW CONSENT AND RELEASE FORM I hereby authorize Bloodline Sports L.L.C. the right and permission to copyright and/or publish, reproduce, or otherwise use my name, voice, and likeness in video, photographs, written materials, and audio-visual recordings. I acknowledge and understand these materials about or of me may be used for both commercial and/or non-commercial purposes. I understand that my image may be edited, copied, exhibited, published and/or distributed. I also understand this material may be used individually or in conjunction with other media in any medium, including without limitation to print publications, digital publications, and/or public broadcasts for any lawful purpose. There is no time limit on the validity of this release nor are there any geographic limitations on where these materials may be distributed. I hereby acknowledge and grant Bloodline Sports L.L.C and its employees, agents, licensees, successors, and third-party organizations have all ownership rights and irrevocable rights and permission to use, copyright, publish, sell, distribute, and/or promote the recorded video, photo, interview, and/or audio. I understand that my participation is voluntary and that I may, at any time, discontinue my involvement before submitting this document. I understand that Bloodline Sports L.L.C. can see no risk presently and that I take full responsibility for my involvement in this project and the risks that it may entail (be they legal, physical, or mental) and release Bloodline Sports L.L.C. from any claims, demands, losses, damages, suits, and liabilities of any kind whatsoever in connection with the foregoing. I hereby certify that I am over eighteen years of age and am competent to contract in my own name insofar as the above is concerned. If I am under eighteen years of age, my parents or legal guardians have read this document and have given their consent by checking"I Agree" below. By checking "I Agree", I acknowledge that I have completely read and fully understand the above consent and release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for marketing, educational, promotional, and/or any other lawful purpose whatsoever.

I Agree: (I am at least 18 years of age upon submission)

I Agree: (I am the parent/guardian of the student/athlete)