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First Name:
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Middle Initial:
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Last Name:
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Street:
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City:
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State:
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Zip Code:
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Home Phone:
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Cell Phone:
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Birthdate:
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Email :
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Gender:
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Team/Club:
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Parent/Guardian #1
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First Name:
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Last Name:
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Home Phone:
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Cell Phone:
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Email :
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Parent/Guardian #2
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First Name:
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Last Name:
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Home Phone:
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Cell Phone:
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Email :
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Medical/Emergency Contact Information
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Emergency Contact:
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Phone:
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Relationship to player:
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RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL
CONSENT AGREEMENT
("AGREEMENT")
IN CONSIDERATION of being permitted to participate in any way in the Indoor Soccer activity ("Activity") I,
for myself for personal representatives, assigns, heirs, and next of kin:
1. ACKNOWLEDGE, agree, and represent that I understand the nature of Indoor Soccer Activities
and that I am qualified in good health, and in proper physical condition to participate in such Activity. I
further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately
discontinue further participation in the Activity.
2. FULLY UNDERSTAND THAT: (a) INDOOR SOCCER ACTIVITIES INVOLVE RISKS AND DANGERS
OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH
("RISKS"); (b) these Risks and dangers may be caused by my own actions or inaction’s, the actions or
inaction’s of others participating in the Activity, the condition in which the Activity takes place, or THE
NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; (c) there may be OTHER RISK AND SOCIAL
AND ECONOMIC LOSSES either not known to me or not readily foreseeable at this time; and I FULLY
ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND
DAMAGES I incur as a result of my participation or that of the minor in the Activity.
3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE CHATTANOOGA SPORTS
COMPLEX, their respective administrators, directors, agents, officers, members, volunteers, and
employees, other participants, any sponsors, advertisers, and, if applicable, owner and lessors of
premises on which the Activity takes place, (each considered one of the "RELEASES" herein) FROM ALL
LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO
BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE,
INCLUDING NEGLIGENT RESCUE OPERATIONS AND I FURTHER AGREE that if, despite this RELEASE
AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my
behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS
EACH OF THE RELEASEES from any litigation expenses, attorney fees, loss, liability, damage, or cost
which may incur as the result of such claim.
I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE
GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT
INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND
UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND
AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE,
NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.
MINOR RELEASE
AND I, THE MINOR’S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF INDOOR
SOCCER ACTIVITIES AND THE MINOR’S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR
TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN
SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO
INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASEE’S FROM ALL LIABILITY
CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR’S ACCOUNT CAUSED OR ALLEGED TO
BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE "RELEASEES" OR OTHERWISE,
INCLUDING NEGLIGENT RESCUE OPERATION AND FURTHER AGREE THAT IF, DESPITE THIS
RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR’S BEHALF MAKES A CLAIM AGAINST ANY OF
THE RELEASEES NAMED ABOVE, I WILL INDEMNITY, SAVE, AND HOLD HARMLESS EACH OF THE
RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR
COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.
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I/we agree with the above
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