Training Waiver Medical Release

PLEASE READ BEFORE REGISTERING

  

Upstate New York Soccer Development Program, LLC Goalkeeper Camp

RELEASE AND WAIVER OF LIABILITY

  

The parent/guardian recognizes and acknowledges that this form will be used in lieu of individual forms for any and all of the events hosted by Upstate New York Soccer Development Program, LLC within its children’s/players. It is further recognized and acknowledged that it is the responsibility of said parent/guardian to inform Upstate New York Soccer Development Program, LLC immediately of any changes or modifications to the information reflected on this form concerning said parent’s or guardian’s child. This form is to be used with but is not limited to, the following activities/events: Upstate New York Soccer Development Program, LLC soccer camps, trainings, team trainings, individual trainings, games, and competitions. By signing this form, the parent/guardian authorizes and agrees to allow Upstate New York Soccer Development Program, LLC to take photographs, video recordings or any other media materials taken of myself and/or children/wards to be used in any marketing/advertising publications by and for Upstate New York Soccer Development Program, LLC included, but not limited to print brochures, advertisements, films or videos and broadcast presentations of any sorts. 

AUTHORIZATION TO TREAT A MINOR PARENT / GUARDIAN MEDICAL RELEASE STATEMENT: I understand that in the event medical intervention is needed, every attempt will be made to immediately contact the person(s) listed on this form. In the event I cannot be reached in an emergency during the activities identified on the front of this form, I hereby give my permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I authorize an adult, in whose care the minor has been entrusted, to consent to any x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or dentist licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. The undersigned shall be liable and agree(s) to pay all costs and expenses incurred in connection with such medical and dental services rendered to the aforementioned child pursuant to this authorization. Should it be necessary for our (my) child to return home due to medical reasons or otherwise, the undersigned shall assume all transportation costs. The undersigned does also hereby give permission for our (my) child to ride in any vehicle designated by the adult in whose care the minor has been entrusted while attending and participating in activities provided by Upstate New York Soccer Development Program, LLC. THIS AUTHORIZATION SHALL REMAIN IN EFFECT FOR ONE YEAR FROM THE DATE IT WAS SIGNED BELOW.

PARENT / GUARDIAN RELEASE OF LIABILITY STATEMENT: I understand all reasonable safety precautions will be taken at all times by Upstate New York Soccer Development Program, LLC and its agents during the events and activities. I understand the possibility of unforeseen hazards and know the possibility of risk, inherent or otherwise, including, but not limited to, accident or illness. In consideration of, and as part payment for, the right to participate in the aforementioned activities and events, I have and do hereby assume all risks on behalf of the aforementioned student/athlete. I agree not to hold Upstate New York Soccer Development Program, LLC, its directors, employees, or volunteer staff liable for damages, losses, disease, or injuries incurred by the subject of this form. I will hold Upstate New York Soccer Development Program, LLC harmless from any and all causes of action, debts, claims, demands, damages, judgment executions, cost, loss of services, expenses, compensation, and any and all other claims of damages whatsoever, including, but not limited to, those arising from the accommodations, any acts or omissions of Upstate New York Soccer Development Program, LLC, or any other person in connection with Upstate New York Soccer Development Program, LLC. I also understand that Upstate New York Soccer Development Program, LLC is held harmless and will not issue credit or refund in the event that I or my minor child, the attendees, cannot attend due to illness, injury, hazardous road conditions, severe storm, flooding, wind, war or other acts of God or any unforeseen occurrences that could frustrate the whole or any part of this event and/or schedule. I understand that Upstate New York Soccer Development Program, LLC does not provide health and/or accident insurance. I assume full and complete responsibility for any and all medical and/or dental bills arising out of (my) or my child’s participation in the Upstate New York Soccer Development Program, LLC provided activity, and hereby agree to indemnify and hold harmless Upstate New York Soccer Development Program, LLC and its parties from any and all liability associated with (my) or my child’s participation in the clinics/camps that are the subject of this form. THIS AUTHORIZATION SHALL REMAIN IN EFFECT FOR ONE YEAR FROM THE DATE IT WAS SIGNED BELOW.

If under the age of 18, waiver must be completed by the participant’s parent or guardian.  By signing below, you are electronically verifying that you have read and agree to the terms and conditions   

of the Upstate New York Soccer Development Program, LLC Release and Waiver of Liability.

Training Waiver Medical Liability Release

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Thank you and we look forward to working with you.

Upstate New York Soccer Development Program, LLC

239 East State St. Ext, Gloversville, NY 12078, US

(518) 332-7970