Please read and accept the Waiver of Liability, Release Assumption of Risk &
Indemnity
Agreement
In consideration of being permitted to participate in any activities sponsored,
coordinated
and/or assumed by the (known hereafter as "the
conference"), individual colleges, universities, sports clubs or any facility at
which I
participate (known hereafter as "the organizations") assume all risk of loss,
damage,
illness, death or injury to person or property which I may sustain while
participating or
engaging in, or as a
result of such activities. I also release the organizations, their officers,
trainers,
administrators, and fellow members and/or associates from any and all claims,
demands and
causes of action on account of any loss or injury, which may occur during my
participation,
involvement with, or as a result thereof, whether arising through negligence,
omission,
default, or any other action of or by the organizations, their officers, trainers,
administrators, fellow members, and/or any person or organization associated with
such
activities. I fully understand that the activities undertaken by the organizations
may
include but are not limited to risks of: heat exhaustion, dehydration, concussion,
sprains,
fractures, abrasions and other injuries to myself and other participants, including
the risk
of permanent injury and/or death.
I further declare that I have received and read all information regarding the
insurance
policy. I have been advised to seek a physical examination in order to determine my
fitness
for all activities undertaken by the organizations and have informed the
organizations of
any physical and/or medical conditions, which may prohibit or limit my participation
in such
activities. I am
aware that there are risks associated with the activities as described above and
that I may
suffer property loss or bodily injury arising out of my participation in the
activities. In
executing this document, I also relinquish any right to sue any of the
organizations, its
officers, trainers, administrators, other members, and/or any person or organization
associated
with activities as a result of any injury, loss, or action involving the
organizations.
However,
I voluntarily choose to assume these risks and participate in the activities. I have
read
and
executed (printed name above and signed below) this document with full knowledge of
its
significance. I further state that I am 18 years of age or older and competent to
execute
this
affirmation and release or I must have parental consent and signature of a parent or
guardian in
order to participate in the activities of the above named organizations.
I further declare that I have received and read all information regarding the
insurance
policy
offered by USA Roller Hockey in affiliation with the conference, and at the time of
signing
this
release, I am currently a member in good active status of USA Roller Hockey or
intend to be
as
mandated by the conference in order to partake in conference events. I understand
that full
facial
protection is mandatory.