Parent/Guardian Waiver and Release of Liability
(Required for participants under the age of 18 at time of registration)
LYSANDER YOUTH HOCKEY, INC.
d/b/a Three Rivers Athletic Complex
IN CONSIDERATION of my child being allowed to participate in any way in the training, events and activities (“Activities”) at Three Rivers Athletic Complex at 2725 W. Entry Road, Baldwinsville, New York (the “Facility”), and related events and activities, the undersigned parent(s) or legal guardian(s), acknowledges, appreciates, and agrees that:
1. The risk of injury to my child from the Activities is significant, including the potential for permanent disability and death, also including viral infections, bacterial infections and other communicable diseases and illnesses, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and
2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of Lysander Youth Hockey, Inc. or others, and assume full responsibility for my child's participation; and
3. I willingly agree to comply with the Activities’ stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child's readiness for participation and/or in the Activities itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and
4. I, for myself on behalf of my/our heirs, assigns, personal representatives and next of kin, hereby release the other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event, hereafter referred to as Releasees, with respect to any and all injury, disability, death, or loss or damage to person or property, also including viral infections, bacterial infections and other communicable diseases and illnesses, incidental to my child's involvement or participation in these programs, whether arising from the negligence of the Releasees or otherwise, to the fullest extent permitted by law.
5. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, hereby agree to assume the risk and hold harmless, release, and otherwise indemnify Lysander Youth Hockey, Inc. its officers, officials, agents, employees and its affiliated organizations and sponsors and the owners of, in the performance of the Facility, from any liability from any and all liabilities incidental to my involvement or participation in the Activities, even if arising from their negligence, to the fullest extent permitted by law.
6. Arbitration: In further consideration of allowing me to participate in the aforementioned activities, I hereby agree to submit to bind arbitration any and all claims, which I believe I may have against the facility arising from my activities at the facility. The arbitration shall be pursuant to the rules of the American Arbitration Association. The arbitrators shall apply the Federal Rules of Evidence to all proceedings.
Arbitration shall be commenced within six (6) months from the date on which any alleged claim first arose. Further, the arbitration shall be held in the town where Lysander Youth Hockey, Inc. is located, unless otherwise mutually agreed to by all the parties. The Submission to the American Arbitration Association shall be unlimited and the arbitration award may be enforced by any court of competent jurisdiction.
7. Publicity Release: I acknowledge Lysander Youth Hockey, Inc. hosts events that are public and camera-friendly. I hereby irrevocably grant Lysander Youth Hockey, Inc. the non-exclusive right to use my name, likeness (e.g. photograph, video tape, etc.) and/or biographical material about me for any legitimate purpose in any media and in such manner and at such times as Lysander Youth Hockey, Inc., in their sole discretion, may deem appropriate or desirable, without compensation to me, provided that such use relates to my presence at Lysander Youth Hockey, Inc. and/or participation in any event and/or program at the Facility. I hereby waive all right of inspection and/or biographical material.
8. Release: This is to certify that I am the parent or guardian of the minor Participant named above, having legal responsibility for this minor, and I do hereby consent (with the approval of my spouse, if any) to the minor’s participation in the Activities and agree to the release of liability as provided above and hereby make and enter into each and every representation, certification, waiver, release, assumption and indemnity described above in the release of liability on behalf of myself, the minor, any other parent or guardian of the minor, and our heirs, assigns, personal representatives, and next of kin. I agree to give up my rights, the minor’s rights, and the rights of any other parent or guardian to maintain any claim or suit against Releasees arising out of the minor's presence or participation in the Activities. I believe and represent that I HAVE LEGAL AUTHORITY TO MAKE THESE WAIVERS AND RELEASES, and I agree to indemnify and defend the Releasees for all liability arising out of any lack of authority on my part to make such waivers and releases.
Date of Birth:
I HAVE READ THIS RELEASE OF LIABILITY, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL LEGAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. BY TYPING MY NAME BELOW THAT WILL ACKNOWLEDGE THE WAIVER AND RELEASE OF LIABILITY.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service