2025 Thriving Third District’s Special Games Athlete Waiver

Athlete Name *

First NameLast Name

Athlete DOB

Date

Disability and Medical Condition

Means of Mobility

Means of Communication

Allergies and/or Dietary Restrictions

Parent/Guardian/Caregiver Name *

First NameLast Name

Email

example@example.com

Phone Number

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I, the undersigned guardian, agree to have him/her present at the 2025 Thriving Third District’s Special Games. I acknowledge that this athletic event carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and or producer of the event, and lack of hydration. I hereby assume all of the risks of Athlete’s participating and/or volunteering in this event. I realize that liability may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them, or because of their possible liability without fault. I certify that Athlete is physically fit, has sufficiently trained for participation in the event, and I have not been advised otherwise by a qualified medical person that Athlete cannot participate. I acknowledge that this Accident Waiver and Release of Liability form will be used by the event holder, sponsors, and organizers in events in which I may participate and that it will govern my actions and responsibilities at said events. I realize every precaution is taken to eliminate any injuries or hazards, and a competent supervisor is present: however, there is inherent risk in participating in this event. In the event of an injury, I hereby waive, release and hold harmless from any liability for damages for personal injury including accidental death, as well as from claims for property damage which may arise in connection with the above named activity, against the supervisor, the County of Riverside, the Third Supervisorial District, Valley-Wide Recreation & Park District, its officers, agents, employees and volunteers. In case of accident or other emergency, personnel of the County of Riverside and/or its agents are hereby authorized to secure medical care deemed necessary as a result of accident or injury for the participant. I further agree to pay any and all costs incurred as a result of said treatment. I further permit the use of activity/event photography and/or video for media promotion. I, the undersigned guardian, agree to stay with my athlete at the Thriving Third District’s Special Games on September 20, 2025. I understand that my athlete will not be able to participate if I am not on site during the event. If I leave the soccer field at Veterans Park (32394 Richardson St., Menifee, CA 92584), my athlete will need to leave as well. By checking this box, I confirm that I have read and understand the above.

Date

Guardian's Signature*