Field Waiver

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Field Waiver Empty Field Waiver

Post  comanche4 on Sun Sep 11, 2011 9:09 am

If you would like to print a waiver and fill it out before a game just copy and print this. Remember if you are under 18 you need you parent or legal guardian approval!

Activity Consent Form and Approval by Parents or Legal Guardian

First name, middle initial and last name of participant __________________________________

Address(residential not PO Box): __________________________________________

City:___________________ State: ______ Zip: ____________

Birth date (month/day/year): ________ Age during activity: ________________

Has Approval to participate in: ________________________ From: __________ to ____________

Please check on:
___ Without Restrictions
___ Special Considerations or restrictions: ____________________________________________

Hold Harmless Agreement
I understand that participation in the activity involves a certain degree of risk. I have carefully considered the risk involved and have given consent for myself or my child to participate in the activity. I understand that participation in the activity is entirely voluntary and requires participants to abide by applicable rules and standards of conduct. I release Southcom Airsoft, the local council, the activity coordinators, and all employees, volunteers, related parties, or other organizations associated with the activity from any and all claims or liability arising out of this participation.
In case of an emergency involving my child, I understand every effort will be made to contact me. In the event I cannot be reached, I hereby give permission to the medical provider selected by the adult leader in charge to secure proper treatment, including hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose to the adult in charge examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and communication with the participant's parents or guardian, and/or determination of the participant's ability to continue in the program activities.

Participants signature: _________________________________________ Date: ____________

Parent/Guardian printed name: ___________________________________________

Parent/Guardian Signature:_____________________________________________ Date: ___________

Emergency Contact (Name, Phone, Relationship to Participant): ___________________________________

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Join date : 2010-02-05
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