Waiver for MID Summer U19 Hockey Tourney July 2022
Sign in to Google to save your progress. Learn more
Last name, first name of participant *
Name of team: *
Name of team manager: *
Name of second team if playing on two:
Name of second team manager if playing on two:
Insurance coverage for accidental injury is required for all participants.  In most instances, family health insurance is adequate.  Please indicate your family health insurance plan below:
Health Insurance Company:
Health Insurance Company Contact Number:
Policy Number:
I/We, being the legal guardian(s) of the participant, authorize Delaware Shore Field Hockey, Inc., and its agents, permission to request medical treatment as necessary to insure the wellbeing of our dependent:   *I/We, the undersigned, for ourselves, our heirs, executors, and administrators, waive and release and forever discharge Delaware Shore Field Hockey, Inc., its staff, officers, agents, representatives, employees, successors, and assigns of and from any and all rights and claims for damages to person or property which may be sustained or occur during participation in this tournament, whether said damages, injury, or loss are due to negligence or not.                                                                                                      *I/We certify that the participant is in good physical condition, allowing her/him to participate in the 2021 United Through Hockey For Change Tournament.
Note: This constitutes a legal signature as per State of Delaware Title 6 Commerce and Trade, Subtitle II – Uniform Electronic Transactions Act.
Participants Name: *
*Parent/Guardian Name: (for participants under the age of 18. If you are over 18 type N/A below) *
Date: *
MM
/
DD
/
YYYY
Please note that this is a FUN tourney and played with that in mind. Sportsmanship is very important to us. We ask that everyone attending, participating and volunteering enjoy him or herself but be respectful and keep sportsmanship in mind. Please respect the umpires, volunteers and other participants. All shots on goal must be safely executed with the understanding that many participants are not at the skill level of some of the more experienced athletes.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy