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                                                 Release, Waiver of Liability, and Consent for Emergency Medical or Dental Treatment

When registering for any Hamilton-Wenham Youth Soccer Association (HWYSA) program, parents and guardians must accept the following release, waiver of liability and consent on behalf of their minor child for emergency care.

I, the registrant, as the parent or guardian of the player I am registering for, do hereby agree and acknowledge the following:

(1) Recognizing the possibility of injury or illness, and in consideration for HWYSA and members of HWYSA accepting my child as a player in the soccer programs and activities of HWYSA and its members (the 'Programs'), I consent to my child participating in the Programs. Further, I hereby release, discharge, and otherwise indemnify HWYSA, its employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the Programs, against any claim by or on behalf of my child as a result of my child’s participation in the Programs.

(2) My child has received a physical examination by a licensed medical doctor and has been found physically capable of participating in the sport of soccer. I have provided written notice attached to this release setting forth any specific issue, condition, or ailment that my child has that may impact my child’s participation in the Programs. I understand and agree that this information will be provided to my child’s coaches and HWYSA Board Members. I give my consent to have a licensed medical doctor or dentist provide my child with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and treatment.

(3) I understand that an uploaded or provided photo will only be used for printing on a credential (i.e. ID, Pass Card, Roster) and will not be used for any other purposes without express consent. I consent to HWYSA and its affiliates taking photographs, video recordings, and/or sound recordings in documenting the activities of HWYSA’s programs and services. I hereby grant HWYSA and its affiliates’ permission to use the negatives, prints, motion pictures, video recordings, audio recordings, or any other reproduction of the same for HWYSA and its affiliates’ educational and promotional purposes in manuals, on flyers, the internet, or other publications.

(4) My child and my child’s parents and guardians will abide by the rules, policies, procedures and protocols as provided by Massachusetts Youth Soccer and all affiliated member organizations, including HWYSA.

(5) I understand and give permission for my child to participate in practices and games where they may be on the field with players of younger or older ages.  I understand and accept there may be risks involved when playing with players of different ages.  I am aware that if I do not accept such risks I may remove my child from the field.

(6) I understand that no jewelry of any kind may be worn during play - no bracelets, necklaces, earrings or rings. Players may not wear beads, barrettes or other hard/sharp items. Newly pierced ears may not be taped. Players may not participate with casts or splints of any kind. There are no exceptions to this rule for the safety of all our players.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY AND FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT I WAIVE SUBSTANTIAL RIGHTS BY ELECTRONICALLY AGREEING TO THESE TERMS. I AGREE TO WAIVE ALL SUCH RIGHTS ABOVE INCLUDING THE RIGHT TO FILE A LEGAL ACTION OR ASSERT A CLAIM FOR PERSONAL OR PHYSICAL INJURY OR DEATH OF ANY KIND. I ELECTRONICALLY SIGN THIS RELEASE FORM FREELY OF MY OWN FREE WILL ON BEHALF OF THE MINOR CHILD I AM REGISTERING TO THE PROGRAMS.

 

Contact

HWYSA
 PO Box 2005
Hamilton, Massachusetts 01982

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