KEELY’S DISTRICT BOXING AND YOUTH CENTER Consent / Waiver Form Please read before signing. Upon my signing of this consent, I _________________________________ (print full name or name of parent), hereby agree to participation of __________________________ (child’s name) in the programs of Keely’s District Boxing and Youth Center.  I acknowledge that participation in this program may involve a risk of physical injury or exacerbation of known or unknown preexisting conditions.  I hereby acknowledge that any injury or worsening of any preexisting condition that may arise from participation in this program is entirely my responsibility  and release / hold harmless Keely’ s District Boxing and Youth Center and its employees, agents, instructors, sponsors, boardmembers, representatives, or volunteers from and against all claims, demands, loss of property or injury to me / my child or children incurred through participation in this program. As this program is open to the public and various types of media (television, radio, newspaper), I understand and give consent for me / my child or children to be photographed and / or interviewed. I hereby assume the risk and I acknowledge that I have carefully read and fully understand this agreement and its content.  By signing this agreement, I also understand that I / my child / my children must remain drug free as this is a drug-free organization and environment. Signature of Participant _____________________________ Parent / Guardian Date ________