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 participation of the above named player; 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 consent to the use of above named player’s image by LLFH 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. However, credits may be applied.