Athlete Registration

MEDICAL INSURANCE: Proof of medical insurance is required to participate in TIRA coordinated actvities.

EMERGENCY CONTACT: If the named custodial parent or guardian can not be reached, please provide an alternate person to call in the case of an emergency.

Note Make sure your rugby team coach and/or club sponsor are aware of any medical concerns (asthma, diabetes) and important medications (inhaler, insulin, epipen).

ACTIVITY RELEASE OF LIABILITY, INDEMNIFICATION AND ASSUMPTION OF RISK AGREEMENT

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ACTIVITIES: Rugby competitions, clinics, and other activities organized and/or governed by Texas Interscholastic Rugby Association ("TIRA") or a TIRA-approved entity. Dependent on the participant's competitive level, age, and/or purpose of the activity, physical engagement may range from non-contact athletic activities to collision maneuvers such as tackling, rucking, mauling, scrummages, and lifting (herein "Activity").

RELEASEESS: Texas Interscholastic Rugby Association, the sponsoring school / school district, and any other associated or affiliated organizations, their respective officers, agents, representatives, sponsors, advertisers, and, if applicable, owners and lessors of any premises used to conduct TIRA activities.

ASSUMPTION OF RISKS: To the best of my knowledge, the named athlete is in good health and has no physical limitations that would preclude or impede the named athlete's participation in the Activity, and I elect to allow the above-named athlete to participate voluntarily and engage in this Activity knowing that the Activity may be hazardous to my property, the above-named athlete’s property and the above-named athlete. I recognize and acknowledge that the possibility for injuries always exists with participation in sports and may include, but not limited to, concussion, fracture, permanent disability or death. I further recognize and acknowledge that participation in a full contact/collision sport such as rugby may increase that possibility. As such, I voluntarily and expressly agree and promise that I assume full responsibility for property loss or damage, and for personal injury, including death, that I or the above-named athlete may sustain as a result of being engaged in this Activity, whether or not based on the negligence or other wrongful conduct of Releasees.

RESPONSIBILITY TO MINIMIZE RISKS: To help reduce the risk of injury or illness, I agree to be solely responsible for ensuring that the above-named athlete:

• has had a sports physical by a licensed physician to determine that he/she is fit to play a contact/collision sports such as rugby prior to participation;
• is covered by medical, dental, and vision insurance with no policy restrictions on or exclusion for participation in sport activities;
• has a fitted mouthpiece / mouthguard for contact activities;
• is well feed and brings plenty of water to stay hydrated;
• removes any external jewelry and ensures nails are trimmed short prior to engaging the Activity;
• understands he/she must abide by all coaching and referee instructions as well as TIRA rules and policies.

INDEMNIFICATION:  In consideration for facilitating the above-named athlete’s participation in the Activity described above, I AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES FROM ANY AND ALL LOSS, LIABILITY, DAMAGE, OR COSTS OF ANY NATURE WHATSOEVER, INCLUDING COURT COSTS AND ATTORNEY’S FEES, THAT THEY MAY INCUR DUE TO THE ABOVE-NAMED ATHLETE’S PARTICIPATION IN THIS ACTIVITY WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES OR OTHERWISE. FOR EXAMPLE, I SPECIFICALLY AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES FROM LOSSES THEY MAY INCUR AS A RESULT OF THE ABOVE-NAMED ATHLETIES INJURIES OR THE ABOVE-NAMED ATHLETE INJURING ANOTHER PERSON OR DAMAGING ANOTHER PERSON’S PROPERTY WHILE PARTICIPATING IN THE ACTIVITY.

RELEASE: In consideration for facilitating the above-named athlete’s participation in the Activity described above, I, individually and as the custodial parent / legal guardian of the above named athlete, release, discharge, and agree not to sue Releasees for any claims, demands, actions, and causes of action of any nature whatsoever including a claim of negligence, arising out of any loss or damage to my or the above-named athlete’s property and any injury, including death, that the above-named athlete may sustain whether or not caused by the negligence of the Releasees, while participating in the Activity, supervised or unsupervised, or while in transportation to and from the Activity.

INTENT: I intend that this Activity Release of Liability, Indemnification and Assumption of the Risk Agreement bind not only me, but also the members of my family and my spouse, and my heirs, assigns, and personal representatives. I intend this as a release, discharge, and promise not to sue the Releasees. I further agree that this Activity Release of Liability, Indemnification and Assumption of the Risk Agreement should be construed in accordance with the laws of the State of Texas.

MEDICAL RELEASE AND AUTHORIZATION

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As Parent and/or Guardian of the above-named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional of the above-named athlete in the event of a medical emergency which, in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the athlete’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the on-site Officials, Coaches and Volunteer Staff to provide the needed emergency care prior to the athlete’s admission to the medical facility.

MEDIA RELEASE

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By participating in the Activity, I consent to the photographing and videographing of my child by persons representing the Releasees and the media. I grant these entities the right to use images of the above-named athlete in all forms for all purposes, including any advertising, trade or commercial purpose, and I waive all royalty and compensation rights.

Signature

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Parent / Guardian

FREE ACT:  I acknowledge that I have read and understand the terms and conditions as set forth above and that this form is legally binding and that I voluntarily as my own free act to be in effect August 1st through July 31st of the stated school year. 

CERTIFY: I certify that I am the custodial parent / legal guardian of the above-named athlete, of lawful age (18 years or older), and legally competent to sign this form 

No player registration fee is being required for participation this season.