Please fill out this waiver form for participation in kickball activities. Your safety and acknowledgment of the rules are important.

Lehighton Adult Kickball League

​I realize that risk of injuries are an inevitable and inherent consequence of participation in any sport activity or trip; and that no amount of reasonable instruction and supervision, proper use of equipment or facilities will prevent all injuries.  I appreciate that such injuries can range from the most insignificant to death, including and not limited to, serious neck and spinal injuries. Serious injury can also occur to all or part of the musculoskeletal or nervous  systems.  All of these potential injuries can impact the general health and well being of participants for the remainder of  their natural lives.
​I have carefully considered how the possible consequences of injury may impact my  life, and I choose to knowingly and voluntarily accept this risk and agree to participate in the designated activity.
​I verify that I am covered by health insurance and that neither the Lehighton Adult Kickball League or any persons associated with the Lehighton Adult Kickball League, are responsible for any health care expenses as a result of my participation in this activity.  If I do not have health insurance, I agree to be totally responsible for any and all health costs associated with any injury I may sustain while participating in this activity.
​I verify that I have no impairments that might endanger myself in the participation of this activity. To maximize my safety in this program, I understand that I must follow any and all applicable regulations, directions and instructions during participation.
​In case of injury as a result of participation in this activity, I hereby give advance permission to obtain medical service on my behalf, including but not limited to , paramedic treatment, transportation by emergency vehicle to a medical facility and treatment by emergency physicians. All extraordinary measures are to be taken in regard to treatment and I shall assume all financial responsibility as to any treatment.  If emergency treatment is secured by any of its members, I will indemnify and hold harmless the Lehighton Adult Kickball League or any associated persons from any and all actions in the decision to seek emergency treatment.
​By my providing my First and Last name  below, I hereby acknowledge that I understand and voluntarily accept, on behalf of myself, my family, and my teammates the hazards, risks, rights and responsibilities noted in the release.