Player Medical Information & Liability Release (Page 2 of 2) in pdf

LIABILITY RELEASE - TALENT RELEASE – TRAVEL AUTHORIZATION

MEDICAL TREATMENT AUTHORIZATION FOR A MINOR

1. My child, ______________________________________, is a minor less than 18 years old and is hereafter referred

to as "my child.” My child has my permission to participate in soccer tryouts, camps, practices, scrimmages, games,

indoor soccer, parties, field trips, and other activities, including travel to and from, hereafter known as “functions”,

which may be scheduled from time to time by the Gryphons Soccer Club, dba FORCE North, or the DeAnza Force

Soccer Club (hereinafter and collectively “Club”).

2. My child is in good health and is able to participate in these functions.

3. My child will use protective equipment (e.g., soccer boots, shin guards, eye protection, head protection, teeth

protection, padded goalkeeper equipment, etc.) or, if my child doesn’t, my child does so at his/her own risk and with

my permission. My child may use his/her head to return or redirect soccer balls that come to my child.

4. While my child is participating in these functions, I HEREBY AUTHORIZE THE ADULT COACHING STAFF,

or in their absence, any accompanying or assisting adult, TO ADMINISTER ANY EMERGENCY FIRST AID OR

MEDICAL ATTENTION “ON THE SPOT,” AND TO CONSENT TO TREATMENTS FOR MY CHILD,

including but not limited to, any x-ray examination, anesthetic, medical, or surgical diagnosis or treatment, and

hospital care which is advised by, and is to be rendered under the general or special supervision of, any physician,

surgeon, or dentist, AND, I AGREE TO PAY FOR SAME. I consider the Club’s soccer academy program to be a

school, and this authorization is given pursuant to the provisions of Sections 6550-6552 of the California Family

Code. This authorization shall remain effective indefinitely, until my child no longer plays with the Club. A

PHOTOCOPY OF THIS SIGNED AUTHORIZATION IS AS VALID AS THE ORIGINAL.

5. I authorize any hospital or provider of medical attention to surrender physical custody of my child to the Club upon

completion of treatment. This authorization is given pursuant to Section 1283 of the Health and Safety Code of

California.

6. I understand that tryouts and some other functions may not be covered by any insurance, and that I AM SOLELY

RESPONSIBLE for the cost of any service or treatment provided that is not covered by insurance.

7. I understand that soccer is a strenuous physical sport, can be dangerous, and there is an inherent risk of injury. I

hereby release and I HEREBY RELEASE AND HOLD HARMLESS THE CLUB, its employees, officers, Board of

Directors, employees, volunteers, parental helpers and assistants, team members and their families, referees and

other game officials, from any and all liability, suits, claims, charges, demands, losses, damages, and expenses

incurred from any and all illnesses and injuries to persons (including, but not limited to, sports program participants

and spectators) and/or damage to property which arise from the my child’s use of the Facility (including ingress and

egress to the Facility), regardless of cause or severity, that may befall my child during functions. I understand that it

is not possible to recognize or correct every dangerous condition or physical field hazard or to anticipate every

injurious event, and I RELEASE AND HOLD HARMLESS the individuals and organizations listed in this

paragraph from those responsibilities. These releases and these authorizations remain valid indefinitely, can only be

changed or revoked in writing, and then, only when signed by the Club.

8. On behalf of members of my family, I authorize the Club to arrange transportation in buses, trains, and planes and

other vehicles and equipment to these functions. My child and family members have my permission to ride in

transportation arranged by the Club, regardless of whether or not vehicles and equipment are owned and/or operated

by commercial transport companies, public utilities, the Club, parents, coaches, or other individuals.

9. Any photographs or videos taken of my child by the Club may be used for promotional and commercial purposes in

printed, audiovisual, or electronic form, including on the Club’s website and brochures.

10. The information I have provided to the Club is true, accurate, and complete. No verbal promises of any nature

contradicting this agreement and release have been made, can be made, or ever will be made to me. Legal fees and

other costs shall be awarded to the prevailing party in arbitrated or legal disputes.

11. I am the parent or legal guardian of my child and am authorized to sign this agreement. I will keep the Club

informed about any changes in the status of parent/legal guardianship for my child.

Player Medical Information & Liability Release Page 2

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