Toronto Junior Roller Derby CONSENT FORMS PACKAGE - 2016/17

Full Name of Skater
First and Last
Your answer
Parent/Guardian Name
First and Last
Your answer
Home Address
Your answer
SKATER CODE OF CONDUCT
By signing below I hereby agree that: 1. I will lead by example and demonstrate good sportsmanship with fellow skaters, coaches, officials, parents, and other attendees at every game and practice. 2. I will attend every practice and game and will be on time for practice and games. I will notify my coach via phone or email if I will be absent. 3. I will listen and learn from my coaches and other league members. 4. I will treat my coaches, other league members, officials, and fans with respect regardless of race, sex, creed, or abilities, and I will expect to be treated accordingly. 5. I deserve to have fun during my sports experience and will tell parents or coaches if it stops being fun! 6. My teammates and I deserve to play in an environment that is safe and free of drugs, alcohol, and tobacco. I will not use or have in my possession any drugs, alcohol, or tobacco before, after, or during any TJRD practices, bouts, or league gatherings of any kind. 7. I recognize the importance of school and will not allow my derby commitment to interfere with my academic success. 8. I will learn the rules of the game of roller derby according to the most current JRDA standards. 9. I will not engage in any behavior that would endanger the health, safety, or well being of coaches, parents, league members, officials, or any other attendees. 10. I will not engage in the use of profanity, verbal or physical threats, or any abuse aimed at coaches, parents, league members, officials or any other attendees. If I fail to abide by the above code of conduct, I will be subject to disciplinary action that could include, but is not limited to: A verbal warning by a TJRD Representative or TJRD Board Member. A written warning by a TJRD Representative or TJRD Board Member. Game suspension. Season dismissal. With documentation of incident kept on file by the TJRD Board of Directors & Coaches.
PARENT CODE OF CONDUCT
By signing below I hereby agree that: 1. I will not force my child to participate in the Toronto Junior Roller Derby League. 2. I will promote the emotional and physical well being of the skaters ahead of any personal desire I may have for my daughter/son to win. 3. I will inform the coach of any physical disability, injury, or illness that may affect the safety of my child or the safety of others. 4. I (and my guests) will not engage in any kind of unsportsmanlike conduct with any official, coach, skater, or parent such as booing and taunting; refusing to shake hands; or using profane language or gestures. 5. I will encourage my child to play by the rules and to resolve conflicts without resorting to hostility or violence. 6. I will encourage my child to treat other players, coaches, officials, and spectators with respect regardless of race, creed, color, sex, or ability. 7. I will respect the officials and their authority during games and will never question, discuss, or confront coaches at the rink, and will take time to speak with coaches at an agreed upon time and place. 8. I will encourage a safe sports environment for my child that is free from drugs, tobacco, and alcohol. 9. I will refrain from coaching my child or other players during games and practices, unless I am one of the official coaches for Toronto Junior Roller Derby. If I fail to abide by the above code of conduct, I will be subject to disciplinary action that could include, but is not limited to: A verbal warning by a TJRD Representative or TJRD Board Member. A written warning by a TJRD Representative or TJRD Board Member. Parental game suspension. Parental season dismissal. With documentation of incident kept on file by the TJRD Board of Directors & Coaches.
PHOTO AND VIDEO RELEASE AGREEMENT
For consideration which I acknowledge, I irrevocably grant Toronto Junior Roller Derby, licensees, assigns, and successors the right to use my image and (skater) name in all forms and media including composite or modified representations for all purposes, including advertising, trade, or any commercial purpose throughout the world and in perpetuity. I waive the right to inspect or approve versions of my image used for publication or the written copy that may be used in connection with the images. I relinquish any right that I may have to examine or approve the completed product or products or the advertising copy or printed material that may be used in conjunction therewith or the use to which it may be applied. I release, licensees, assigns and successors from any claims that may arise regarding the use of my image including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright. Toronto junior Roller Derby Is permitted, although not obligated, to include my name as a credit in connection with the image. I have read and understood the photo release agreement. I (the undersigned) do hereby confirm the consent heretofore given you with respect to your photographing me, or my child in connection with any Toronto Junior Roller Derby video. Additionally I hereby grant to you, your successor, assigns, and licensees the perpetual right to use, as you may desire, all motion pictures and sound track recordings which you may make of me or my child, and the right to use my name and/or child’s name or likeness in or in connection with the exhibition or any other use of such video or recording.
WAIVER OF LIABILITY, RELEASE ASSUMPTION OF RISK & INDEMNITIY AGREEMENT
It is the purpose of this agreement to exempt, waive and relieve releasees from liability for personal injury, property damage, and wrongful death, including if caused by negligence, including the negligence, if any, of releasees. “Releasees” include: TORONTO JUNIOR ROLLER DERBY Hereby referred to as TJRD, its affiliate associations, local associations, member teams, event hosts, other participants, coaches, officials, sponsors, advertisers, and each of them, their officers, directors, agents and employees. For and in consideration of the undersigned participant’s registration with TJRD, its affiliates, local associations and member teams and being allowed to participate in events and member team activities, participant (and the parent(s) or legal guardian(s) of participant, if applicable) waive, release and relinquish any and all claims for liability and cause(s) of action, including for personal injury, property damage or wrongful death occurring to participant, arising out of participation in events, member team activities, the sport of roller derby, and/or activities incidental thereto, whenever or however they occur and for such period said activities may continue, and by this agreement any such claims, rights, and causes of action that participant (and participant’s parent(s) or legal guardian(s), if applicable) may have are hereby waived, released and relinquished, and participant (and parent(s)/guardian(s), if applicable) does(do) so on behalf of my/our and participant’s heirs, executors, administrators and assigns. Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledge, understand and assume all risks relating to roller derby and any member team activities, and understand that roller derby and member team activities involve risks to participant’s person including bodily injury, partial or total disability, paralysis and death, and damages which may arise therefrom and that I/we have full knowledge of said risks. These risks and dangers may be caused by the negligence of the participant or the negligence of others, including the “releasees” identified below. These risks and dangers include, but are not limited to, those arising from participating with bigger, faster, and stronger participants, and these risks and dangers will increase if participant participates in roller derby and member team activities in an age group above that which participant would normally participate in. I/We further acknowledge that there may be risks and dangers not known to us or not reasonably foreseeable at this time. Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledge, understand and agree that all of the risks and dangers described throughout this agreement, including those caused by the negligence of participant and/or others, are included within the waiver, release and relinquishment described in the preceding paragraph. I/We agree to abide by and be bound under the rules of TJRD, including the By-Laws of the corporation and the arbitration clause provisions, as currently published. Copies are available to TJRD members upon written request. Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledge, understand and assume the risks, if any, arising from the conditions and use of roller derby rinks/facilities and related premises and acknowledge and understand that included within the scope of this waiver and release is any cause of action (including any cause of action based on negligence) arising from the performance, or failure to perform, maintenance, inspection, supervision or control of said areas and for the failure to warn of dangerous conditions existing at said rinks, for negligent selection of certain releasees, or negligent supervision or instruction by releasees. If the law in any controlling jurisdiction renders any part of this agreement unenforceable, the remainder of this agreement shall nevertheless remain enforceable to the full extent, if any, allowed by controlling law. This agreement affects your legal rights, and you may wish to consult an attorney concerning this agreement. Participant (and participant’s parent(s)/guardian(s), if applicable) agree if any claim for participant’s personal injury or wrongful death is commenced against releasees, he/she shall defend, indemnify and save harmless releasees from any and all claims or causes of action by whomever or wherever made or presented for participant’s personal injuries, property damage or wrongful death. Participant (and participant’s parent(s)/guardian(s), if applicable) acknowledge that they have been provided and have read the above paragraphs and have not relied upon any representations of releasees, that they are fully advised of the potential dangers of roller derby and understand these waivers and releases are necessary to allow amateur roller derby to exist in its present form. Significant exclusions may apply to TJRD’s insurance policies, which could affect any coverage. For example, there is no liability coverage for claims of one player against another player.
PARENTAL AUTHORIZATION / MEDICAL RELEASE
I, parent or legal guardian, of the above named dependant hereby give authorization for participation in any and all Toronto Junior Roller Derby and Junior Roller Derby Association activities. I hereby grant permission to managing personnel and league representatives to authorize and obtain medical care from any licensed physician, hospital, or medical clinic, should the skater become ill or injured while participating in league activities when neither parent nor legal guardian is present to grant authorization for immediate treatment. I assume all risks and hazards incidental to such participation, including transportation to and from league activities, and do hereby waive, release, indemnify and agree to hold harmless the TJRD, JRDA, and any Junior League and its agents, assigns, representatives, officers, and employees from any and all claims arising out of the skater’s participation in any and all league activities. I HAVE READ AND UNDERSTAND THE HEALTH REGISTRATION FORM AND PARENTAL AUTHORIZATION / MEDICAL RELEASE. I VERIFY THAT I HAVE COMPLETED THIS FORM AND THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT. I FURTHER AGREE TO ABIDE BY THE RULES/GUIDELINES SET FORTH BY THE JUNIOR ROLLER DERBY ASSOCIATION AND MY REGIONAL JUNIOR ROLLER DERBY LEAGUE, TORONTO JUNIOR ROLLER DERBY.
MEDICAL INFORMATION
Please list below, any medical, social or emotional conditions which may be relevant to the coaching, care and treatment (emergency or otherwise) of your child/league member. All information will remain confidential unless it is necessary to share with the coaches to assist in the success of your child/league member's derby experience.
Your answer
*ELECTRONIC SIGNATURE & DATE - Skater/League member
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*ELECTRONIC SIGNATURE & DATE - Parent/Guardian
by typing your name in the field below you are providing your electronic signature.
Your answer
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