Emergency Contact Information
Please enter the name and phone number of the person you wish us to contact in case of an emergency.
Please enter any medical condition or information that we need to be aware of.
I understand that Lasting Legacy Field Hockey (LLFH) does not provide medical insurance for players in the event of illness or injury requiring medical treatment. In consideration of being allowed to participate in any way in LLFH programs, related events and activities, I acknowledge and agree that: (1) The risks of injury and illness (MRSA, influenza, and COVID-19) from the activities involved in this program are significant, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and, (2) I knowingly and assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation; and, (3) I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual hazard, I will remove the above named player from participation and immediately bring such to the attention of the nearest coach; and, (4) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless LLFH their officers, coaches, agents, and/or other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct program (“releasees”), with respect to any and all injury, illness, disability, death, or loss or damage to person or property, whether arising from the negligence of the releasees or otherwise, to the fullest extent permitted by law.
I hereby accept any and all responsibility for, and assume the risk of any and all injury and damages to the above named player, which may arise directly or indirectly as a result of and or participation in Lasting Legacy Field Hockey Program.
Lasting Legacy Field Hockey and its employees, coaches, and officers cannot be held responsible for any and all injuries that may occur. If medical attention is required in any Lasting Legacy Field Hockey activity, I give permission for such medical care to be administered.
I hereby consent to the use of above named player’s image by Lasting Legacy Field Hockey for any and all purposes including without limitation, video, still photographs, publications, and any trade or advertising purpose.
I also understand that there are no refunds or credits. I certify that I am familiar with the contents of this release, that I have read and understand the same, and that it is my intention by signing this release that the same is binding not only to me, but my heirs, administrators, executors, successors and assigns.