Personal Waiver - 2009
Waiver
RELEASE OF LIABILITY
Release of All Claims: I, __________________________, agree that in consideration for the registrant
being allowed to participate in and ASHLAND SOCCER CLUB soc-
cer programs and activities (referred to as PROGRAMS below) I agree as follows: I agree to
release, waive, discharge and indemnify OYSA and ASHLAND SOCCER CLUB, from any and all liabilities,
claims, demands or causes of action that may arise, by or on behalf or my family or dependents from or related to any loss,
damage, permanent disability or injury, including death sustained by the me while they are participating in
the PROGRAMS and/or while the registrant is being transported from the same, which transportation I hereby au-
thorize. This release, waiver, discharge and indemnification clause includes any claims for injury and death based
on negligence of ASHLAND SOCCER CLUB and any owner or manager of locations where programs take place
including but not limited to; The City of Ashland, Ashland Family YMCA, Ashland School District #5, their employees
and agents. As a participant, I am fully aware of the risks connected with participation in the PROGRAMS. These risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, my personal condition, equipment, vehicular traffic, actions of other people includ-
ing, but not limited to, participants, volunteers, spectators, coaches, event officials and monitors, and lack of hydra-
tion. I, therefore, expressly assume all of the foregoing risks and accept personal responsibility for my personal safety.
Consent for Medical Treatment: I certify I am in good
physical condition and I have no knowledge of any physical condition, injury, or illness whatsoever that would
place me at risk to participate in the ASHLAND SOCCER CLUB PROGRAMS. I also hereby give consent
for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care
may be given under whatever conditions are necessary to preserve the life, limb or well-being of the registrant.
Code of Conduct: I agree to abide by all rules of
and ASHLAND SOCCER CLUB its affiliated organizations and sponsors. Additionally, I hereby acknowledge
that we have received, read, understand and agree that our family and guests will fully abide by all rules for
the Ashland Soccer Club Adult League. I recognize that referees and club officials have authority to remove players and spectators from the premises.
All Ashland Soccer Club programs are smoke-free, drug-free activities. Alcohol use before and during the games is strictly prohibited.
Players and spectators under the influence of drugs or alcohol will be asked to leave the premises at the discretion of referees or
coordinators. Alcohol comsumption after games is also prohibited both on the premises of games or in the parking lot.
Expulsion from Participation:
I understand as a player I will be expelled from participation without any refund of fees for;
1) Attempting to participate in activities while under the influence of drugs or alcohol. __________ (please initial)
2) Physically or verbally threatening a referee or coordinator ___________________
3) Bringing any type of weapon to the game premises whether on person or in my vehicle __________________
4) Foul and abusive language to referees or fellow players __________________________
5) Assaulting another player or referee at any time __________________________
6) Refusing to follow directions given by a coordinator or referee __________________________
_________________________________________________ _________________________
Adult Member's Signature Date
|
