Glass City - Waiver.xls
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Canton Akron Cup Youth Team Waiver
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TEAM NAME ______________________________ Coach ____________________________________
Age Bracket_______________________________
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TEAM CONTACT ____________________________________________
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PlayersLegal Guardian
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First NameLast Name First NameLast NameDatePARENT’S SIGNATURE
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Waiver Form
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REPRESENTATIONS, ACKNOWLEDGEMENTS, AND AGREEMENTS:
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1. I hereby represent and certify that the age of the registrant listed is correct and acknowledge and agree that the registrant is physically fit
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to engage in both structured and unstructured activities at the Canton Akron Cup.
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2. I acknowledge the inherent risk of serious injury or even death associated with soccer activities and I hereby release, discharge, and agree to
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indemnify and hold harmless Bowling Green State University its Board of Trustees,
Officers, Employees & Agents, Valentis Athletica LLC,
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Net Results LLC, its owners, managers, affiliates, and employees and from any and all claims by or on behalf of the registrant
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arising from the registrant’s participation in activities at the Canton Akron Cup.
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3. I have received and viewed the "Return to Play - What Parents-Guardians Need to Know " concussion information sheet.
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4. I herby represent and certify that the registrant has adequate health insurance to cover any and all injuries occurring as a result of participation
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in soccer activities at the Canton Akron Cup and as participant, I hereby consent to any and all emergency medical care for participant and
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agree to pay for same.
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I certify that the above information is correct
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Coach or Team Contact ___________________________________________
_____________________________________
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Date
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