Player Profile

Medical Information and Emergency Release

Medical Information:

Are there any medical conditions that Timoteo should be aware of about your teen?  Is there anything that would hinder his activity?  By signing this permission slip you are stating that your teen is medically cleared by a doctor to play flag football.

Please list any Special Medical Conditions: Allergies, Chronic Illness, or other conditions/instructions below:

 

Emergency Release:

I also hereby release and agree to hold harmless all of the sponsors of this league and the church sponsoring my teen’s team; as well as designated leaders, and their respective personal representatives, successors and assigns (the “Released Parties”) from all claims, demands, causes of action, damages, expenses, and liability for damage, illness, or injury, which have resulted or may result from the alleged acts or omissions of the Released Parties. In case of emergency involving injury or illness, I give permission to administer and/or order medical treatment.

First Aid & Emergency

Medical Treatment

I recognize that there may be occasions where my youth may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury.  I do hereby give permission for agents of this organization to seek and secure any needed medical attention or treatment for my youth including hospitalization, if in the agencies’s opinion that such need arises.  In doing so, I agree to pay all fees and costs arising from this action to obtain medical treatment.

I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery and, again, I agree to pay for the medical treatment.

WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19
ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT
In consideration of being allowed to participate on behalf of the Timoteo Philadelphia, Inc. athletic program and related events and activities, the undersigned acknowledges, appreciates, and agrees that:

1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,
2. I KNOWINGLY AND FREELY 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 as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Timoteo Philadelphia, Inc. their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

 

 

Release to Use Image and Likeness

On occasion, Timoteo Philadelphia, Inc. or its representatives (hereafter referred to as "Agencies") may take photographs or make an audio or videotape recording of children and/or adults involved in the aforementioned functions and activities. Such photographs or video records may be used by staff and participants to remember the activities and participants.

Local news organizations may hear of our activities or events, and our "Agencies" may invite or allow them to photograph or record our events for news reporting on special interest features.  I consent to the use of any such audio or visual record of my youth to be used, distributed or displayed as agents of the organization see fit.  This consent includes but is not limited to: photographs, videotape and audio recordings. Furthermore, I give my youth express permission to be interviewed by the news media, or for such photographs and other audio or visual records to be used by the news media.

In addition, such photographs and audio/visual recordings may be used in publications or advertising materials to let others know about our activities. These images may also be used by the "Agencies" or its agents to produce ministry resources for staff training, League promotions, or other uses to promote the various ministries/organizations involved in this endeavor.  The "Agencies" may also make these materials available for sale to the public.

 

 

 

Waiver/Release for Communicable Diseases including COVID-19   ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT

In consideration of being allowed to participate on behalf of this athletic program and related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19.  While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, 2. I KNOWINGLY AND FREELY 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 youth's participation; and, 3. I willingly agree that my youth will comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases.  If, however, I observe any unusual or significant hazard during my youth's presence or participation, I will remove him/her from participation and bring such matters to the attention of the nearest official immediately; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the aforementioned "Agencies" and their Board members, officers, officials, agents, and/or employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the functionsa and activities (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 

SPECIAL DISCLAIMER:

Participant agrees to indemnify, defend and hold Timoteo Philadelphia, Inc. & Urban Affairs Coalition (UAC), and any partner organizations and their officers, directors, employees, or agents (the "Indemnified Parties") harmless from any and all claims, demands, actions, liabilities, damages, judgments, and costs, including, without limitation, attorney’s fees, whether or not incurred in the course of litigation, that may be asserted against UAC that result from the acts or omissions of Timoteo & Timoteo employees, agents or partnering organizations, if any. The indemnity set forth above shall survive the expiration or earlier termination of this Agreement. The rights of the parties under this agreement shall be in addition to and not in limitation of the rights, damages or recourse to which any of them may otherwise be entitled under this Agreement, in law or in equity.

I HAVE READ THE ABOVE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT AS WELL AS THE MEDICAL DISCLAIMERS, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I, therefore, do hereby grant permission for my child to participate in the functions and activities of "Timoteo Philadelphia, Inc" (including its, off the field, mentoring programming) for the duration of a full year beginning with the date of my signature below

If you have any questions, please contact Timoteo Staff via their information below.

Thank you and God bless!

 

Timoteo Staff

info@timoteosports.org

Buddy, Programs Staff/FootballCommissioner: 267-262-1220

Eric, Assistant to Executive Director 570-807-1121

Pastor Rob, Executive Director: 215-470-8406