Waiver Of Liability Emergency Care And Media Release Form (Page 2 of 2) in pdf

EMERGENCY Authorization:

Prince William Ice Center has my permission to call 911, and/or send my child to the Hospital, and the

medical personnel have my permission to provide treatment that a physician deems necessary for the

well-being of my child. Prince William Ice Center will make every attempt to contact the

Parent/Guardian/Emergency Contacts in the event of such an emergency.

Parent/Guardian Signature: ___________________________________________ Date: ______________

AMATUER ATHLETIC WAIVER/RELEASE OF LIABILITY:

In consideration of being allowed to participate in any way in the sports program, related events and

activities, the undersigned acknowledges, appreciates, and agrees that:

1. The risk of injury from the activities involved in this program is significant, including the

potential for permanent paralysis and death, and while particular rules, equipment and personal

discipline my reduce the risk, the risk of serious injury does exist; and

2. I knowingly and freely assume all such risk, both known and unknown, even arising from the

negligence of the releases or others, and assume full responsibility for my participation; and

3. I willingly agree to comply with the stated and customary terms and conditions for the

participation. If however I observe an unusual significant hazard during my presence or

participation, I will remove myself from participation and bring such to the attention of the

nearest official immediately; and

4. I myself and on behalf of my heirs, assign, personal representatives and next of kin, hereby

release and hold harmless Prince William Ice Center, their officers , officials, agents and/or

employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable

owners and leasers of the premises used to conduct the event(release), with respect to any and

all injury, disability, death, or loss or damage to person or property, whether arising from the

negligence of the releases or otherwise.

I DO _____ / DO NOT _____ give my permission to Prince William Ice Arena to use my child’s

photo or likeness in marketing and/or promotional materials.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY

UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS TO

SIGNING IT AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Signature of participant: ______________________________________Date:_____________

(Signature of participant’s legal guardian if participant is under age 18)

Waiver Of Liability Emergency Care And Media Release Form Page 2