Play As One

PLAY AS ONE

Release of Liability
Thank you for taking the time to fill out our forms. We are taking every precaution to ensure a safe, smooth and healthy experience for our co-curricular activities. Please fill this form out with your student-athlete. Signatures for both the parent and student must be entered in order for your student to participate.

Thank you,

-PLAY AS ONE Team

Parent & Student Athlete Information
PARENT NAME:*
PARENT PHONE:*
PARENT EMAIL:*
example@example.com
STUDENT-ATHLETE NAME:*
IS YOUR CHILD A MINOR (BELOW 18):*
TEAM NAME:*
ADDRESS:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

1. In consideration of being permitted to participate in any way in Play as One, Fellowship of Christian Athletes, and Emmanuel Faith Community Church activities (“Activity”) I, for myself, my personal representatives, assigns, heirs, and next of kin: 1. ACKNOWLEDGE, agree and represent that I understand the nature of the Activity and that I am qualified, in good health, and in proper physical condition to participate in such Activity. I further agree and warrant that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activity.

2. I FULLY UNDERSTAND that:(a) ATHLETIC ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH (“RISKS”); (b) these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE ‘RELEASES’ NAMED BELOW; (c) there may be OTHER RISKS AND SOCIAL AND ECONOMIC LOSES either not known to me or not readily foreseeable at this time, and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSES, COSTS, AND DAMAGES I incur as a result of my participation or that of the minor in the Activity.

3.I HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE Play as One, Fellowship of Christian Athletes, and Emmanuel Faith Community Church including its parent company, related affiliated and subsidiary companies of each, as well as the officers, directors, agents, employees and assigns of each, and associations, clubs, coaches, officials, administrators, members, volunteers, participants, sponsors, advertisers, and if applicable owners and lessors of premises on which the Activity takes place, and any other party indemnified and held harmless by Emmanuel Faith and PAO (each considered one of the ‘RELEASES” herein) FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PARTY BY THE NEGLIGENCE OF THE

4. ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT I, or anyone on my behalf, makes a claim against any of the Releases, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASES from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of such claim. AGREEMENT TO PARTICIPATE I, or we, grant to the Directors, Assistants, or assigned chaperons of this event to act as guardians/spokesman in granting permission for emergency treatment/hospitalization (including anesthesia) if necessary for my child en route to or from or at the site of a Play as One, Fellowship of Christian Athletes, and Emmanuel Faith Community Church event or hospital or other medical facility. I understand that should a health emergency arise, I will be attempted to be notified, but that if I cannot be reached by telephone, such medical treatment as deemed necessary, by competent medical personnel is authorized.INSURANCE: Play as One, Fellowship of Christian Athletes, and Emmanuel Faith Community Church provide excess medical insurance for any member athlete participating in Play as One, Fellowship of Christian Athletes, and Emmanuel Faith Community Church season and club sanctioned practice or event. If the athlete has other medical coverage, theirs will be applied first, followed by Play as One, Fellowship of Christian Athletes, and Emmanuel Faith Community Church insurance.

5.INSURANCE: Play as One, Fellowship of Christian Athletes, and Emmanuel Faith Community Church provides excess medical insurance for any member athlete participating in a Play as One, Fellowship of Christian Athletes, and Emmanuel Faith Community Church league, camp or event. If the athlete has other medical coverage, theirs will be applied first, followed by Play as One, Fellowship of Christian Athletes, and Emmanuel Faith Community Church insurance. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

PRINTED NAME OF PARTICIPANT*
Phone Number

Area CodePhone Number
PARTICIPANT'S SIGNATURE (only if age 18 or over)

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Minor Release
MINOR RELEASE: AND I, THE MINOR’S PARENT AND/OR LEGAL GUARDIAN, UNDERSTAND THE NATURE OF ATHLETIC ACTIVITIES AND THE MINOR’S EXPERIENCE AND CAPABILITIES AND BELIEVE THE MINOR TO BE QUALIFIED, IN GOOD HEALTH, AND IN PROPER PHYSICAL CONDITION TO PARTICIPATE IN SUCH ACTIVITY. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS EACH OF THE RELEASES FROM ALL LIABILITY, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON THE MINOR’S ACCOUNT CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PARTY BY THE NEGLIGENCE OF THE “RELEASES” OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS AND FURTHER AGREE THAT IF, DISPITE THIS RELEASE, I, THE MINOR, OR ANYONE ON THE MINOR’S BEHALF MAKES A CLAIM AGAINST ANY OF THE RELEASES NAMED ABOVE, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE RELEASES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE, OR COST ANY MAY INCUR AS THE RESULTS OF ANY SUCH CLAIM.
PRINTED NAME OR PARENT/GURADIAN:*
Date

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Date
PARENT/GUARDIAN SIGNATURE (only if participant is under the age of 18):

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Student Athlete Name:*
Date:

MonthDayYear
Date
Student-Athlete Signature:

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Parent & Student Athlete Information

Minor Release