VOLUNTARY RELEASE-WAIVER-ASSUMPTION OF RISK AND FULL INDEMNITY AGREEMENT
PLAYER ID_______
__________________ PICTURE PERMISSION automatic YES unless otherwise advised- Y N
Today’s Date
___________________________________ ___________________ Sex: M F
Print Child’s First and Last Name (Legibly) Birth Date
___________________________________ ___________________ ______________
Street Address City and State Zip Code
_____________________________ __________________________ ____________________
Email Allergies: Home Number
_________________ _________________ ________________________________
Work Number Cell Number Parents Names- Mom & Dad
__________ ______________ ________________ ________________________________
Age Group Location of Camp Day/Time of Camp Past Participant? How Many Times?
FOR THE CHILD NAMED HEREIN IS UNDER EIGHTEEN YEARS AND FOR MYSELF THE PARENT OR GAURDIAN I
AGREE TO THE TERMS AND CONDITIONS
I, Participant’s parent or legal guardian, hereby consent and affirm the foregoing VOLUNTARY RELEASE-WAIVER-
ASSUMPTION OF RISK AND FULL INDEMNITY AGREEMENT On behalf of the participant, myself, and the participant’s family
and all other parties as stated above. By affirming and consenting to the Voluntary Release-Waiver-Assumption of Risk and Full
Indemnity Agreement, it is my intention that terms of the document by and through my consent are as effective as if the participant
were an adult rather than a minor.
_________________________________________ _________________________________________
Print Parent’s or Guardian’s Name Legibly Parent’s or Guardian’s Signature Date
The undersigned participant hereinafter referred to as the “undersigned” requests and is granted the revocable permission to enter upon
the premises of City parks or facilities used by Susie Ohle, hereinafter referred to as “owner”, to participate as a player or a coach in
said soccer games and/ or matches, and /or camps, and /or practices, and /or scrimmages, and /or other activities tat may be conducted
within the Owner’s premises. Said entry shall hereinafter be referred to as “revocable permissive entry”.
In consideration of the “revocable permissive entry”, onto the premises of Owner, the undersigned of himself/herself, all personal
representatives executors, executrixes, heirs next of kin, spouse, and assigns do hereby agree as follows:
1. the undersigned do hereby FULLY RELEASE, FULLY WAIVE, FULLY DISCHARGE, AND COVENANT NOT TO SUE,
the operators or Owner, its officers, directors, shareholders, employees, agents, managers, attorneys, subsidiaries, independent
contractors, successor or assigns, (herinafter collectively referred to as “releasees”) and each of them, from any and all claims, and/or
the ordinary negligence of released, and/or the strict liability, and/or the negligence of any third party or participant, which causes the
undersigned injury, death, personal injury, bodily injury, property damages, or any other type or kind of injury, and.or loss, and/or
damages. The undersigned hereby convenants to hold “releasees” harmless from and to fully indemnify “releasees” for any type or
kind of damages, judgements, awards, or related expenses (including but not limited to releasees’ attorney fees and court costs) that
“releasees” may incur as a result of the participation of the undersigned in any activity, and/or game, and /or match, and/or practices,
and/or camps, and/or scrimmages, and/or leagues, conducted within Owners premises at any time.
