Assumption of Risk Agreement
Physician Release
I, the
undersigned parent/legal guardian of
authorize said child’s full participation in the Pennsylvania
Passing League, including all related activities.
It is my understanding that participation in activities that make up the
Pennsylvania Passing League is not without some inherent risk of injury.
As such, in consideration of my child’s participation in the
Pennsylvania Passing League, I covenant not to sue the league, its’ financial
sponsors, TSF Radio Network, U.S. Army, (NAME OF SCHOOL WHERE EVENT IS BEING
HELD), their officers, servants, agents or employees and release, waive, and
discharge said parties from any and all liability, claims demands, action, and
causes of action whatsoever arising out of or related to any loss, damage, or
injury, including death, that may be sustained by my child, whether caused by
the negligence of the releases, or otherwise while participating in such
activity, or while in, or upon the premises where the activity is being
conducted. I also give my permission
for any emergency medical care or treatment by a physician, surgeon, hospital,
or medical care facility that may be required, including transportation and
accept responsibility for the cost.
Without
the signature of the parent/legal guardian, the individual named above will not
be allowed to participate in any Pennsylvania Passing League event.
PRINT PARTICIPANTS NAME:
___________________________________________________
DATE:_______________________________________________________________________
PERSONAL INSURANCE &
POLICY NUMBER_______________________________________
_____________________________________________________________________________
EMERGENCY CONTACT PHONE
NUMBER:________________________________________
PARENT/GUARDIAN
SIGNATURE_________________________________________________
DATE:_______________________________________________________________________