LA Reta Registrations

Player's Name*

First NameLast Name

Date of Birth*

Date

Instagram Handle:*

Enter your Instagram Handle

ATHLETIC WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT

There are certain inherent risks associated with participating in sports and/or athletic training that cannot be eliminated. These risks include, but are certainly not limited to: (1) minor injuries such as scratches, cuts, bruises and strains; and (2) major injuries such as injuries to the eyes, infection, loss of sight, joint injuries, back injuries, heart attacks, concussions, paralysis and even death. Also included in these risks are the same or similar injuries that might result from using training equipment, actual use of a field or training facilities, the acts of others or from the unavailability of emergency staff or emergency medical care (hereinafter we shall define all of these risks and potential injuries as “Risks”). All of these Risks will be present in the activities that you and/or your minor will be participating in at LA COMUNIDAD - LA Reta (the “Activities”). HAVING READ THIS PARAGRAPH and having an appreciation for and an UNDERSTANDING OF THESE RISKS, you here by affirm that you and/or your minor’s participation in these Activities is voluntary and that you agree on behalf or yourself or your minor to all of the following:

1. ASSUMPTION OF RISK I, on behalf of myself and/or my minor, ASSUME ALL OF THE RISKS THAT MAY OR CAN ARISE OUT OF PARTICIPATING IN THE ACTIVITIES, INCLUDING BUT NOT LIMITED TO THE ATHLETIC ACTIVITY ITSELF, USE OF THE EQUIPMENT, FIELD OR FACILITIES, THE ACTS OF OTHERS OR THE UNAVAILABILITY OF EMERGENCY CARE, as well as those Risks described in the preceding paragraph.

2. INDEMNITY/HOLD HARMLESS I, on behalf of myself and/or my minor and/or our heirs, personal representatives and/or assigns, also agree to indemnify and hold LA COMUNIDAD - LA Reta, as well as their affiliates, parents, subsidiaries, assigns, partners, attorneys, members, employees, independent contractors, shareholders, officers, directors, and agents or any producers, investors, cast members or any other person or entity associated in any way with the ownership, operation or affiliation with recreational facilities and the creation, production or distribution of LA COMUNIDAD - LA Reta-related marketing content on any LA COMUNIDAD - LA Reta-owned website, harmless from any and all claims, causes of actions, lawsuits, arbitrations or proceedings as well as from any expenses, judgments, costs, fees, damages, expenses and/or liabilities, including attorneys’ fees incurred in defending or prosecuting any such claims brought against LA COMUNIDAD - LA Reta as the result of my or my minor’s participation in the Activities. I hereby allow LA COMUNIDAD - LA Reta to use my or my minor’s image or likeness without current or future compensation for marketing purposes related to LA COMUNIDAD - LA Reta

3. RELEASE/WAIVER In consideration for being permitted to participate in the Activities, I, on behalf of myself and/or my minor and/or our heirs, personal representatives and assigns HEREBY RELEASE, WAIVE AND DISCHARGE LA COMUNIDAD - LA Reta from any and all liability associated with or related to my or my minor’s participation in the Activities and agree NOT TO SUE LA COMUNIDAD - LA Reta for any reason resulting from or associated with my or my minor’s participation in the Activities. This waiver and release is intended to include all claims for injuries, accidents, illnesses, or property loss, whether known or unknown or anticipated or unanticipated, which are in any way related to or associated with the Activities.

4. NO INSURANCE I, on behalf of myself and/or my minor, acknowledge that LA COMUNIDAD - LA Reta does not carry insurance on behalf of myself or my minor. I, on behalf or myself and/or my minor, understand and acknowledge that I/we are surrendering valuable legal rights in this agreement.

5. SEVERABILITY I, on behalf or myself and/or my minor, understand and expressly agree that this agreement is intended to be as broad and inclusive as permitted by the law of the State for which it is used and that if any portion of this agreement is held invalid, it is agreed that the balance of the agreement shall continue in full force and effect and that whatever portion is held invalid shall be interpreted and construed to afford as much protection to LA COMUNIDAD - LA Reta as permitted by the applicable law

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date*

Date

Signature*

Parent/Guardian Information (needs to be filled out for players under the age of 18)

Parent/Guardian Name

First NameLast Name

Cell Number

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, 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 minor’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 LA COMUNIDAD . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

I am the parent and/or legal guardian of the above named minor participant. I have read this agreement thoroughly and understand all of the terms. I understand that I am surrendering legal rights on behalf of the minor and myself. I, on behalf of myself and my minor, agree to be bound by all of the terms of this agreement and also give my consent to allow my minor to participate in the Activities described herein. I release and agree to indemnify and hold harmless the Releasees from any kind and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from the negligence of the releases, to the fullest extent permitted by law.

Player's Name

First NameLast Name

Parent/Guardian Name

First NameLast Name

Date

Parent/Guardian Signature

Would you like to Pay Now or Later: (Paying now secures your spot for the event)

Pay Now (PayPal, Venmo, etc)Pay Later or Alternative (Zelle, Cashapp, etc.)

My Products*

LA Reta Entry

$10.00

Total

$0.00

Pay through:

Zelle: 323-219-8735

Cashapp: $lacomunidad

*** Please note your RSVP is not accepted until payment is made

Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info

LA Reta

Player Information