Player
*
First Name
Last Name
Player Age
*
DOB
*
MM
DD
YYYY
Gender
*
Boy
Girl
Jersey #
*
Jersey Size
*
YS
YM
YL
S
M
L
Parent's Name
*
First Name
Last Name
Parent's Phone
*
(###)
###
####
Email
*
Waiver and Release of Liability *
I, as the legal Parent, Guardian of the child mentioned above, do hereby release, Leo Gibson, LG Soccer Academy LLC, Hamilton Athletic Complex, its owners, employees, contractors, agents, officers, volunteers, and managers from any and all claims arising from personal injury no matter how caused, which my child may incur or suffer during my child's participation in LG soccer programs. I hereby waive any claims, suits, actions, or causes which I or my child may or hereafter have against Leo Gibson, LG Soccer Academy LLC, Hamilton Athletic Complex, its owners, employees, contractors, agents, officers, volunteers, and managers for personal injury, no matter how caused which I or my child may have incurred, may incur or suffer during my child's participation in soccer drills, scrimmages or sessions. I further agree to indemnify and hold forever harmless, Leo Gibson, LG Soccer Academy LLC, Hamilton Athletic Complex, its owners, employees, contractors, agents, officers, volunteers, and managers, and successors against all losses, including counsel fees and court costs, from any and all claims made against it by any party as a result of my or my child's actions, negligent or intentional, which may result in the injury or loss to another participant or spectator. In addition, in the event that I cannot be reached, I hereby give permission to the Training/Camp Director to obtain appropriate medical treatment for my child. I, the parent (guardian) of the child mentioned above, give permission for the named camper to receive emergency medical or surgical treatment and hospitalization if necessary. I understand that every attempt will be made to contact me, or the emergency contact named above, before taking this action. I will be financially responsible for any medical attention needed during training or camp or resulting from an injury received at training or camp. My medical insurance shall be the insurance coverage for any medical treatment. I further agree that my child can receive over-the-counter remedies. (Tylenol, Sudafed, etc.) I HAVE READ THIS HEALTH FORM AND RELATED CERTIFICATIONS, THE RELEASE OF LIABILITY, AND THE ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND THEIR TERMS AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGNING IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
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By signing this waiver, I agree to the above terms and conditions.