K-6 Winnebago Soccer Camp Registration and Waiver Form

Child's Full Name*

First NameLast Name

Child's Grade*

Shirt Size*

Emergency Contact Information: Include Name, Phone and/or Email*

Parent/Guardian Waiver Agreement and Consent*

 1. Assumption of Risk I, the undersigned, understand that participation in a youth soccer camp involves inherent risks, including but not limited to: physical exertion, falls, collisions, contact with other participants, exposure to outdoor elements, and potential injury. I voluntarily assume full responsibility for any risk of loss, property damage, or personal injury that may result from participation in this event.  &#13;&#10;2. Waiver and Release In consideration of the opportunity to participate in the Siouxland United FC Youth Soccer Camp, I hereby RELEASE, WAIVE, DISCHARGE, and COVENANT NOT TO SUE Siouxland United FC, Ho-Chunk Inc., their respective directors, officers, employees, volunteers, agents, affiliates, sponsors, and representatives (collectively, the “Released Parties”) from any and all liability, claims, demands, losses, or damages caused or alleged to be caused in whole or in part by the negligence or fault of the Released Parties or otherwise, arising out of or related to participation in the camp.  &#13;&#10;3. Indemnification I agree to INDEMNIFY and HOLD HARMLESS the Released Parties from and against any and all claims, actions, suits, procedures, costs, expenses, damages, and liabilities, including attorney’s fees, brought as a result of my child’s participation in the camp and to reimburse them for any such expenses incurred.   &#13;&#10;4. Medical Authorization I authorize the camp staff to act according to their best judgment in any situation requiring medical attention for my child. I further understand that I am responsible for all costs incurred as a result of medical care or emergency transportation.  &#13;&#10;5. Media Release I grant permission to Siouxland United FC and Ho-Chunk Inc. to use photographs, video, and/or audio recordings of my child taken during the camp for promotional or educational purposes, without compensation.  &#13;&#10;6. Severability If any portion of this agreement is held to be invalid or unenforceable, the remaining terms shall continue in full legal force and effect.

LIABILITY WAIVER AND RELEASE OF CLAIMS  For Participation in Siouxland United FC Youth Soccer Camp  Organized by Siouxland United FC and Sponsored by Ho-Chunk Inc.