Fall 2023 HCS Referee Contact Info & Waiver
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Email *
Referee Contact Info
Referee Name *
Referee Social Security Number *
Required for tax purposes
Referee Address *
Referee City, State, Zip *
Referee Cell Phone (required for referees 18 and older)
Referee Email (required for referees 18 and older)
Parent/Guardian Contact Info - required for referees under 18
Please choose only one parent /guardian who will be responsible for the referee during this season.
Parent/Guardian Name
Parent/Guardian Cell Phone
Parent/Guardian Email

Hendricks Community Soccer Referee Release Form 

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Recognizing the possibility of physical injury associated with soccer, I hereby release, discharge and/or otherwise indemnify Hendricks Community Soccer, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of the fields and facilities utilized for the Programs, (collectively, the "Released Parties"), against any claim by or on behalf of the registrant.


I understand that participation in soccer involves the risk of serious injury, including permanent disability or death, and severe social and economic losses that might result not only from the participant's actions but the action or inaction of others, including the "Released Parties."

 

I agree to hold Hendricks Community Soccer of Indiana harmless and not liable for any illness, injury, or accident which occurs during participation in the program or when traveling to or from practices or games or related activities.

 

I further release, relinquish, and waive any and all claims that we may have for any accident, injury, or illness which occurs as a result of participation in Hendricks Community Soccer League Incorporated.

 

Parental agreement:

I agree that in the event my child is injured in my absence, I want the referee named below to be transported and admitted to any hospital facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the below-named referee.  I further agree that all such costs incurred as a result of injury to my child be the sole responsibility of parent or guardian.
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