Chicago Summer Shootout Waiver
PLEASE FILL OUT. ANSWER BELOW THE QUESTIONS!! DO NOT REPLACE QUESTIONS WITH YOUR ANSWERS. PROVIDE ANSWERS BELOW THE QUESTION. THANK YOU
Player First Name
Player Last Name
True Grand Rapids
Primary Phone Number
Primary Guardian Name
Emergency Contact Name
Emergency Contact Number
PLEASE READ CAREFULLY:I the undersigned (if applicant/participant is 18 years of age or older) or parent/guardian of the above listed minorapplicant/participant, acknowledge and fully understand that each applicant/participant will be engaging in activities (the “Programs”) that involve risk of serious injury, including permanent disability or death and severe social and economic losses which might result not only from their own actions, inactions and negligence but the actions, inactions or negligence of others, the rules of play or the conditions of the premises or of any equipment used and further, that there may be other unknown risks not reasonably foreseeable at the time, and assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death, and hereby release, discharge, and covenant to indemnify and not sue US Lax Events, Inc., its affiliated organizations and sponsors, its coaches, managers, employees and associated personnel, officers, members of the Board of Directors, agents, including the owners and lessees of premises used to conduct the Programs, all of which are hereinafter referred to as “Releasees,” from any and all liability to each of the undersigned, his/her heirs or next of kin for any and all claims by or on behalf of the applicant/participant as a result of the applicant/participant’s participation in the Programs and/or being transported to or from the Programs. I hereby give my consent to have an athletic trainer, coach and/or doctor of medicine or dentistry or associated personnel to provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I also agree to save and hold harmless and indemnify each and all parties herein referred to above and release said Releasees from all liability, loss, cost, claim or damage whatsoever, including death or damage to property which may be imposed upon said Releasee because of any defect in or lack of such capacity to so act or caused or alleged to be caused in whole or in part by the negligence of the Releasee. PHOTO WAIVERParticipants or their parent (if participant is under the age of 18) permit the taking of photos, video and audio tapes during US Lax Events programs and events for the publication in US Lax Events brochures, website, advertising and use as US Lax Events deems necessary.
By Digitally Signing (typing my Full Name) below I am acknowledging my agreement to the conditions outlined in the above waivers/releases.
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