Stars 2020 Coach Release Form
All head coaches, assistant coaches & lesson providers should complete this form.
Email address *
Coaches Return to Play Waiver and Release - PLEASE READ
Coaches Return to Play Waiver and Release

It is required that all adult managers and coaches review and acknowledge the following Return to Play Waiver and
Release (this “Waiver”). Please review this Waiver and submit the acknowledgment form below.
COVID-19. COVID-19 is a new coronavirus. For more information, please see the websites of the CDC
(https://www.cdc.gov/coronavirus/2019-ncov/index.html) and the State of Illinois
(http://www.dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/coronavirus).

WAIVER and RELEASE

In consideration of being allowed to participate in any way with the Lake County Stars, Inc., an Illinois not-for-
profit corporation, athletics/sports program (the “Stars”), including all related events and activities, the undersigned
acknowledges, appreciates, and agrees that:

1. The risk of injury and/or illness from the activities involved in the program is significant, including the
potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may
reduce the risk, the risk of serious injury does exist;

2. The risk to have contact with individuals, who have been exposed to and/or have been diagnosed with one
or more communicable diseases, including but not limited to COVID-19 or other medical conditions, diseases, or
maladies does exist, and it is impossible to eliminate the risk that I could be exposed to and/or become infected
through contact with or close proximity with an individual with a communicable disease. I fully understand the
nature of those risks, and have had the opportunity to discuss them with the Stars. I assume all risks involved in
your participation with the Stars and other Releasees. That includes any risks that may arise from negligence or
carelessness.

3. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN,
EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERS, AND ASSUME ALL
FULL RESPONSIBILITY FOR MY PARTICIPATION. I AM RESPONSIBLE FOR MY HEALTH AND
CERTIFY TO THE STARS THAT I DO NOT HAVE A HEALTH CONDITION THAT A MEDICAL
PROFESSIONAL HAS RECOMMENDED NOT PARTICIPATING;

4. I willingly agree to comply with the stated and customary terms and conditions for participation. This
includes any mandated application of personal protective equipment, including but not limited to facemasks and
gloves. If, I observe any unusual significant hazard during my presence or participation, I will remove myself from
participation and bring such to the attention of the nearest official immediately; and

5. I, FOR MYSELF AND ON BEHALF OF MY HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES
AND NEXT OF KIN, HEREBY RELEASE AND HOLD HARMLESS LAKE COUNTY STARS, INC., AN
ILLINOIS NOT-FOR-PROFIT CORPORATION, ITS SUBSIDIARIES, THE VILLAGE OF LONG GROVE,
ILLINOIS, THE VILLAGE OF LAKE ZURICH, ILLINOIS, THE LONG GROVE, ILLINOIS PARK DISTRICT,
THE HAWTHORN WOODS, ILLINOIS PARK DISTRICT, THE LAKE ZURICH, ILLINOIS PARK DISTRICT,
AND THEIR RESPECTIVE OFFICERS, OFFICIALS, AGENTS AND/OR EMPLOYEES, OTHER
PARTICIPANTS, SPONSORING AGENCIES, SPONSORS, ADVERTISERS, AND IF APPLICABLE, OWNERS
AND LESSORS OF THE PREMISES USED TO CONDUCT THE EVENT (COLLECTIVELY, THE
"RELEASEES"), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, OR LOSS
OR DAMAGE TO PERSON OR PROPERTY, WHETHER ARISING FROM THE NEGLIGENCE OF THE
RELEASEES OR OTHERWISE.

6. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT,
BEFORE ACKNOWLEDGING THE CHECKBOX BELOW, FULLY UNDERSTAND ITS TERMS,
UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY AGREEING TO IT ON MY OWN
BEHALF, AND I SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

ACKNOWLEDGEMENT BY ADULT PARTICIPANT: By acknowledging and agreeing to the checkbox
below, I agree and verify the following: 1) I consent and agree to assume the risks of participation in these
programs; and 2) that I specifically agree to the release as provided herein of all the Releasees, and, for myself, my
heirs, assigns and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to
my involvement or participation in these programs EVEN IF ARISING FROM THE NEGLIGENCE OF THE
RELEASEES OR OTHERWISE. I ACKNOWLEDGE AND AGREE THAT THE RELEASEES NOT
RESPONSIBLE FOR THE ACTS, OR OMISSIONS OF THIRD PARTIES.

4840-9364-8316, v. 2
Coach Full First and Last Name *
Please list only one coach name below. Each coach will need to submit this form individually.
Please acknowledge that you have read, understand and agree with the "Coach Return to Play Waiver and Release" above. If yes, click I agree and then submit this form.
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