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PLAYERS NAME______________________________________________________
Email _________________________________________________________________
DATE OF BIRTH _______ / ______ / ______ PHONE# ( _______ ) _____________
SIGNATURE indicates you have Read & are in agreement with
SAMBA SOCCER “RULES & POLICIES “and SAMBA SOCCER “WAIVER
OF LIABILITY”
Release and
waiver of liability, assumption of risk and indemnity and parental
consent agreement (“AGREEMENT”)
In
consideration of being permitted to participate in SOCCER –
DODGEBALL- FLAG FOOTBALL activity (“Activity”) I, for
myself, my personal representatives, assigns, heirs and next of kin:
1.
ACKNOWLEDGE, agree and represent that I understand the nature of SOCCER
– DODGEBALL- FLAG FOOTBALL activities and that I am
qualified in good health, and in proper physical condition to
participate, in such activity. I further agree and warrant that
if at any time I believe conditions to be unsafe; I will immediately
discontinue further participation in the Activity.
2.
FULLY UNDERSTAND that A SOCCER – DODGEBALL- FLAG FOOTBALL)
Activities involve risk and dangers of serious bodily injury,
including permanent disability, paralysis and death
(“RISK”): B)these risks and dangers may be caused by my own
actions or inaction’s, the actions or inaction’s of other
participating in the Activity, the condition which the Activity takes
place, or THE NEGLIGENCE OF THE “RELEASEES” NAMED BELOW
C)there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSSES either not
known to me or not readily foreseeable at this time; and I FULLY
ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILTY FOR LOSSES,
COSTS AND DAMAGES I incur as a result of my participation or that of
the minor in the Activity.
3.
HEREBY RELEASE, DISCHARGE AND COVENT NOT TO SUE SAMBA SOCCER,
their respective administrators, directors, agents, officers,
members, volunteers, and employees, other participants, and any
sponsors, advertisers, and if applicable, owners and lesser of
premises on which the Activity takes place, (each considered one of
the “RELEASEES” herein) FROM ALL LIABILITY, CLAIMS,
DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLGED TO BE I
WHOLE OR IN PART BY THE NEGLIENCE OF THE “RELEASEES” OR
OTHERWISE, INCLUDING NEGLIGENT RESUE OPERATIONS, AND FUTHER AGREE
that if, despite this RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF
RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf make claim
against any of the releases, I WILL IDEMNIFY, SAVE AND HOLD HARMLESS
EACH OF THE RELEASEES from any litigation expenses, attorney fees,
loss, liability, damage, or cost which any may incur as the
result of such claim.
4.
MINOR RELEASE and
I, the minor’s Parent and /or Legal guardian, understand the
nature of SOCCER – DODGEBALL- FLAG FOOTBALL Activities
and the Minor’s experience and capabilities and believe the
minor to be qualified, in good health, and in proper physical
condition to participate in such activity. I HEREBY RELEASE,
DISCHARGE AND COVENT NOT TO SUE SAMBA SOCCER, AND AGREE TO
IDEMINIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ALL
LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES I ON THE MINOR’S
ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE
NEGLIENCE OF THE “RELEASEES” OR OTHERWISE, INCLUDING
NEGLIGENT RESCUE OPERATIONS, AND FUTHER AGREE that if, despite this
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY
AGREEMENT THE MINOR, or anyone on the MINOR’S behalf make claim
against any of the releases, named above, I WILL IDEMNIFY, SAVE
AND HOLD HARMLESS EACH OF THE RELEASEES from any litigation expenses,
attorney fees, loss, liability, damage, or cost which any may
incur as the result of such claim.
I HAVE
READ THIS AGREEMENT, AND 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
INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY
TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION
OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING,
SHALL CONTIUNE IN FULL FORCE AND EFFECT.
** SAMBA SOCCER is ONLY obligated
to contact team coach or Captain in event of schedule changes.
NO REFUNDS and NO CREDITS once schedules have been posted online www.samba-soccer.com
Participants/Parent/Guardian Signature ____________________________________
DATE: _____/_______/______