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WAIVER OF LIABILITY AND MEDICAL RELEASE
PLAYER NAME: ______________________________________________________
TEAM: ____________________________________ AGE: U-_____
RELEASE, WAIVER AND INDEMNITY AGREEMENT
In consideration of the opportunity to participate in the HSC 3 v 3 Summer League and activities at the William Wilt Soccer Complex, (the “Facility”), in which I actually participate (“Activities”), I, for myself, my personal representatives, assigns, heirs and next of kin:
1. Acknowledge, represent and agree that I understand the nature of the Activities, and that I am qualified, in good health, and in proper physical condition to participate in the Activities.
2. Fully understand that: (a) the Activities involve risks and dangers of serious bodily injury, including, without limitation, permanent disability, paralysis and death (“Risk”); (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activities, the Facilities, or the negligence of the Releasees named below; (c) there may be other risks and losses either not known to me or not readily foreseeable at this time; and I fully accept and assume all risks of losses, costs and damages, whether or not they are now known or foreseeable, I incur as a result of my participation in the Activities to the extent that the losses, costs and/or damages are the result, whether directly, indirectly or otherwise, of the actual or alleged negligence of anyone or more of the Releasees.
3. Agree and warrant that I will examine the Facility and that if I observe any unusual, significant danger or hazard, I will remove myself from participation and bring such condition to the attention of the nearest official.
4. Hereby release and discharge, and covenant not to sue, the Harrison Soccer Club or the township of Harrison, its members, managers, agents, officers and employees (the “Releasees”), from/for any and all liability, claims, demands, losses or damages caused or allegedly caused in whole or in party by the negligence of any of the Releasees, and waive any liability of, or any claim I may have against, any Releasee as a result, in whole or in part, of the negligence of any of the Releasees; and I further agree that if, despite this release, waiver of liability, assumption of risk, and indemnity agreement, anyone on my behalf makes a claim against any of the Releasees based upon the negligence or alleged negligence of any on or more Releasees, I will indemnify and hold harmless each of the Releasees from any expense of litigation, attorney fees, loss, liability, damage, or cost.
I have read this Agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and have signed it freely and without any inducement or assurance of any nature and intent it to be a complete and unconditional release of all liability for negligence to the greatest extent allowed by the law; and I agree that if any portion of the Agreement is held to be invalid, the balance shall continue in full force and effect notwithstanding.
This is to certify that I as parent/guardian with legal responsibility for this participant do consent and agree to his/her release as provided above, and for myself, my heirs, assigns and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child’s involvement or participation in the Activities, EVEN IF ARISING FROM THE NEGLIGENCE OF RELEASEES.
CONSENT TO MEDICAL TREATMENT:
Additionally, in consideration and acceptance of my entry by the Harrison Soccer Club and the right to participate in related activities, I consent to receive any and all emergency medical treatment as may be deemed appropriate under the existing circumstances as then deemed by the league organizers.
Name of Participant: (print) __________________________________________
Player / Guardian Signature:__________________________________________