ASSUMPTION AND ACKNOWLEDGEMENT OF RISK AND RELEASE OF LIABILITY AGREEMENT
By submitting this form I, the participant or parent/guardian of the above listed minor (if participant is under the age of 18), acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability or death, and severe social and economic losses which might result not only from their own actions, inactions or negligence, but action, inaction or negligence of others, the rules of play, or the condition of the premises or of any equipment used and further, that there may be other unknown risks not reasonably foreseeable at this time, assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death, hereby release, discharge, covenants to indemnify and not to sue The Grove Foundataion, Grove Soccer United, or GSU, its directors, officers, employees, coaches, managers, agents, sponsors and associated personnel including those of its affiliated organizations, and the owners and lessors of premises used to conduct the events, all of which are hereinafter referred to as 'releasees', from any and all liability to each of the undersigned, his/her heirs or next of kin for any and all against any claim by or on behalf of the participant as a result of the participant's participation in any Grove Foundation or Grove Soccer United event or program and/or being transported to or from the same, which participation, after careful consideration I hereby authorize, and which transportation I hereby authorize.
PHOTO/ VIDEO RELEASE
I hereby voluntarily and without compensation authorize visual images and/or voice recordings to be made of the participant by or on behalf of the Grove Foundation, Grove Soccer United, and other sponsoring entities during the program. I also authorize the foregoing entities and their assigns to reproduce, modify, publicize, broadcast and display any such visual images or voice recordings, with or without my name, without notice or payment of any royalty, fee, or other compensation of any character to me for the use of my image, name or voice.
MEDICAL RELEASE/ CONSENT
I hereby give my consent to have an athletic trainer, trained first aid parent, coach and/or doctor of medicine or dentistry or associated personnel to provide the participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I, also agree to save and hold harmless and indemnify each and all parties herein referred to above as releasees from all liability, loss, cost, claim or damage whatsoever, including death or damage to property, which may be imposed upon said releasees because of any defect in or lack of such capacity to so act or caused or alleged to be caused in whole or in part by the negligence of the releasees.
IMPORTANT: RETURN TO PLAY AND GSA CONCUSSION POLICY:
In the event that a participant received any kind of injury, the participant will be monitored closely, and the GSU reserves the right to remove a participant from participation in any session if symptoms are too severe to continue.
PLEASE NOTE: IF DIAGNOSED WITH ANY TBI (TRAUMATIC BRAIN INJURY), THE PARTICIPANT WILL NOT BE ABLE TO RETURN TO PLAY UNTIL A LETTER IS RECEIVED BY GSU FROM A DOCTOR OR MEDICAL PRACTITIONER THAT FULLY CLEARS THE ATHLETE FOR A RETURN TO PARTICIPATION.
I acknowledge that I have read the foregoing and I fully understand the contents.