Waiver Form
In consideration
of being allowed to participate in any way with the Western Reserve Stars, the
undersigned:
• Agree that prior to participating, they will inspect the playing facilities
and equipment to be used, and if they
believe anything is UNSAFE,
they will immediately advise
their coach or supervisor of such
condition(s) and REFUSE TO PARTICIPATE.
• Agree that the parent(s) or legal guardian(s) will instruct the minor
participant that prior to participating, they should inspect the facilities and equipment to be used,
and if the participant believes anything is UNSAFE, they should immediately advise their coach or supervisor of such conditions and
REFUSE TO PARTICIPATE.
• Acknowledge and fully understand that each participant will be engaging in
activities that involve risk of serious injury including permanent disability
and death, and severe social and economic losses which
might result not only from their actions, inactions or negligence,
but the actions, inactions or negligence of others, the rules of play, or the
condition of the premises or of any equipment used. Further, that there may be other risks not
known or not
reasonably foreseeable at this time.
• Acknowledge that it is the participant’s responsibility to be properly
insured and/or pay all medical costs in the event of an injury and to be
knowledgeable of where to contact assistance in the case of an emergency.
Assume all foregoing risks and accept personal responsibility for the damages
following such injury, permanent disability or death.
• Release, waive, discharge and covenant not to sue the Western Reserve Stars,
their respective administrators, officers, directors, agents, coaches and other
volunteers of the organization, mentioned above, other participants, sponsoring
agencies, corporate sponsors, advertisers, and, if applicable, owners and
leasers of the premises used to conduct the event all of which are hereinafter
referred to as “releases”, from 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 releaser or otherwise.
In the event that
injury or illness while competing in any Western Reserve Stars event, I hereby authorize any emergency first aid, medication, medical treatment or surgery necessary by licensed
medical personnel. I also give my permission for attending medical personnel to
execute on my behalf if I am not immediately available to do so. This includes the cost for transportation to
an emergency facility and/or hospital.
THE UNDERSIGNED HAS READ THE ABOVE WAIVER AND RELEASE, UNDERSTANDS THAT
THEY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT
VOLUNTARILY.
Signature
(each parent/legal guardian of minor
participants must sign a release and
waiver of liability form to
participate)
PRINTED Participant’s
Name____________________________________________________________
Address
______________________________________________________________________________
Phone Number
_______________________________________Cell _____________________________
Participant’s
Date of Birth _____________________Grade ______________
Printed Parent
or Legal Guardian __________________________________
EMAIL
Address ________________________________________________
Parent or Legal
Guardian’s Signature and Date_____________________________________________
Emergency
Contact _____________________________________Ph, # ____________________
Uniform information
Last
Name_____________________________________________
Preferred Number ____________2nd
choice___________________
Shooting Shirt
______________________________________