2013 Team Roster and Liability Waiver

Team Roster and Liability Waiver 

Team Name: ________________________________  Coach’s Name: _________________________
Email Address:_______________________________________________(for schedule and rules)
Phone #:  _____________________ Division:  Men’s    Women’s    HS Boys   HS Girls    MS Boys    MS Girls  (please circle one)
AMATEUR ATHLETIC WAIVER AND RELEASE OF LIABILITY In consideration of being allowed to participate in any way in the TEMPLAR CLASSIC 3V3 SOCCER TOURNAMENT: 1. I agree that prior to participating, I will, or if I am the parent or guardian of a minor participant, will instruct such participant that he or she should inspect the facilities and equipment to be used, and if I believe anything is unsafe, I will immediately advise my coach (if I am participating as an athlete) or supervisor of such condition(s) and refuse to participate.   2. I acknowledge and fully understand that I may be engaging in activities that involve risk of serious injury, permanent disability, or death, and severe social and economic losses which might result not only from my own actions, inactions or negligence by actions, inaction or negligence of others, the rules of play, or the conditions of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.   3. I assume all the forgoing risks and accept personal responsibility for the damages following any such injury, permanent disability, or death.   4. Intending to be legally bound, I do hereby release, waive, discharge, and covenant not to sue MANTI HIGH SCHOOL, sponsor of the TEMPLAR CLASSIC 3V3 SOCCER TOURNAMENT, its affiliates, their respective administrators, officers, directors, agents, coaches, and other employees or volunteers of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasers of premises used to conduct the event, all of which are hereinafter referred to as “releasees,” from any and all liability to each of the undersigned, his or her heirs and next of kin for any claims, demands, losses, or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise in connection with association or entry in and/or arising out of my travel to, participation in, and returning from competition.    5. In the event that I sustain injury or illness while competing in the TEMPLAR CLASSIC 3V3 SOCCER TOURNAMENT, I hereby authorize any emergency first aid, medication, medical treatment, or surgery deemed necessary by licensed medical personnel. I also give my permission for attending medical personnel to execute on my behalf my permission forms or other necessary medical documents and to act in my behalf if I am not immediately able to do so. THE UNDERSIGNED HAS READ THE ABOVE WAIVER AND RELEASE AND UNDERSTAND THAT HE/SHE HAS GIVEN UP SUBSTANTIAL RIGHTS BY VOLUNTARILY SIGNING THIS WAIVER       Team Roster – Please Print Legibly Name Age Grade Emergency  # Athlete Waiver Signature, if athlete is under 18, this must be a Parent/Guardian Signature   1.         2.         3.         4.         5.
COACH/TEAM REPRESENTATIVE SIGNATURE : ________________________ DATE _________