TEAM NAME ____________________________
COACHED BY ___________________________
CURRENT YEAR _________________________
CURRENT FEES DUE _____________________
INSURANCE PAID __________________
Insurance Waiver, Emergency Medical Care Policy, Indemnity and Hold Harmless Agreement and Discipline
Policy
PLEASE READ CAREFULLY BEFORE SIGNING
Welcome to our homeschool sports team. For liability purposes
we are asking each parent to sign the following form, providing their agreement to the policy:
-I understand that participation
in the team is voluntary and that some events may take place at visiting facilities.
-If my child's behavior is disruptive
to the rest of the participants, I understand that I or my spouse will be notified at the end of that days event. On a second
occasion, if my child's behavior is disruptive, the child will be unable to participate for the day. On a third occasion,
if my child's behavior is disruptive, he/she will be escorted to me or my spouse at the end of the days event and will not
be permitted to be on the team for the remainder of the year.
-By signing this form, I agree not to hold the above
team or sponsoring organization or any of their members or trustees, liable for any injuries that may occur to my child(ren)
while participating in the teams activities.
-I authorize the Coaching staff to select and secure medical attention including any medical transport as may be necessary
for my child as a result of injuries or other events requiring emergency care while I/we are not in attendance at such event.
-I hereby release said coaches or organizers from any and all liability on account of such selection or authorization for
any and all damages which occur on account thereof.
- I realize that this team and it’s organization do NOT provide insurance protection and that my child is playing
at their own risk.
I ___________________________________ (parent’s name)
agrees to indemnify and hold harmless the
________________________________(association name) and it’s employees/volunteers, from and against all claims, damages,
losses and expenses, including attorneys fees in case it shall become necessary to file an action arising out of performance
of the work herein which is (1) for personal or bodily injury, illness or death, or for property damage, including loss of
use, and (2) caused in whole or in part by __________________’s (children’s names) negligent act or omission or
that of a subcontractor, or that of anyone employed by them or for whose acts contractor or subcontractor may be liable. This
indemnification and agreement shall apply in all instances whether the __________________________(organizations name) is made
a party to the action or claim or is subsequently made a party to the action by third-party in-pleading, or is made a party
to a collateral action arising in whole or in part from any of the issues emanating from the original cause of action or claim.
I have read and do understand the insurance waiver, emergency medical care policy, indemnity and hold harmless agreement
and the discipline policy herein and I agree to abide by and adhere to it's terms.
By: _________________________________(signature of parent)
Date:___________________
Emergency Phone Number :________________________
Medical Insurance Co. and ID#
____________________________________________
Email Addy: _________________________________
