Phantoms Player Waiver Packet

WAIVER AND RELEASE OF LIABILITY

READ THIS ENTIRE DOCUMENT AND HYPERLINK TEXT DOCUMENTS for
reference, BEFORE SIGNING.

I acknowledge that I am fully aware of the potential dangers of participation in any sport and I fully understand that participation in football, cheerleading, dance and/or step may result in SERIOUS INJURIES, PARALYSIS, PERMANANET DISABILITY AND/OR DEATH. Furthermore, I fully acknowledge and understand that protective equipment does not prevent all participant injuries.

I HAVE REVIEWED THE USA FOOTBALL PARENT/GUARDIAN GUIDE accessible at:
https://guides.usafootball.com/5593/54847/index.html.

HELMET WAIVER (for football participants)

We acknowledge, AND WE understand the risks involved in my CHILD/WARD, my
playing FOOTBALL, which is a collision sport; the National Operating Committee on
Standards for Athletic Equipment (NOCSAE) committee has adopted the following
warning to be read by, and signed by, both the parent/guardian and participant. DO NOT USE THIS HELMET TO BUTT, RAM OR SPEAR AN OPPOSING PLAYER, THIS IS IN
VIOLATION OF FOOTBALL RULES AND CAN RESULT IN SEVERE HEAD, BRAIN OR NECK INJURY, PARALYSIS OR DEATH AND POSSIBLE INJURY TO YOUR OPPONENT, THERE IS A RISK THAT THESE INJURIES MAY ALSO OCCUR AS A RESULT OF AN ACCIDENTAL CONTACT WITHOUT INTENT TO BUTT, RAM OR SPEAR, NO HELMET CAN PREVENT ALL SUCH INJURIES.
Player Name*

First NameLast Name
Parent/Guardian Signature*
Date*

MonthDayYear
Date

CODE OF CONDUCT
The ideology of youth sports including this program is to promote good understanding
and fundamental knowledge of football and cheer. It is also critical that good
sportsmanship including the ability to always conduct oneself in an appropriate manner of positive accord both on and off the field. It is understood that any incident considered detrimental to the pursuit of this ideology will not be tolerated. It will be addressed in accordance with the statutes of the association, league, state and local laws, and may result in dismissal from the program and the inability to participate in any future related activities of the association. This code of conduct applies to all involved with the program including but not limited to, the football players, cheerleaders, spirit participants, parents and guardians.

SCHOLASTIC FITNESS
I am of the opinion that my child/ward is scholastically fit and would benefit by
participation in this program. I agree to submit a copy of my child/ ward's last completed grade, end of year/last complete report card or a written statement of scholastic fitness from the school administration.

EQUIPMENT UNIFORM RESPONSIBILITY
I assume full responsibility for any and all equipment/uniforms loaned to my child/ward and I agree to promptly return, upon request, the uniform and other equipment in as good condition as when received except for normal wear and tear.
If I fail to adhere to this policy, I will be responsible for and promptly pay the
replacement cost of such equipment.

I have the legal authority and capacity to enter into this Agreement on behalf of
my child/ward I have read and understand and agree to bind myself and my
child/ward to the above terms on this page and the page preceding. I have had
ample opportunity to review this information and seek legal advice and consulted
with my child/ward’s physician in determining to agree to these terms. I consent
to the above PERMISSION TO PARTICIPATE, Scholastic Fitness, Helmet Waiver,
CODE OF CONDUCT, and Equipment Uniform Responsibility. Any questions I have I have reviewed with the Association of Freeport Phantoms.
Signature*
Date*

MonthDayYear
Date

PARTICIPANT UNDERSTANDING OF RISK
I understand the seriousness of the risks involved in participating in this program, my
personal responsibilities for adhering to rules and regulation, and accept them as a
participant.
Player Name*

First NameLast Name
Player's Signature*
Date*

MonthDayYear
Date

IN CONSIDERATION OF_______________[INSERT CHILD NAME], my child/ward
(“child”), being allowed to participate in the Freeport Phantoms, the undersigned
acknowledges and agrees that:

The risks of injury and illness to my child from the activities involved in these programs are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness, including but not limited to concussions and traumatic brain injuries, do exist; and,

1. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL
SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation; and,

2. I willingly agree to comply with Freeport Phantom’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and,

3. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal
representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS
FREEPORT PHANTOMS; its directors, officers, officials, agents, employees,
volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if
applicable, owners and lessors of premises used to conduct the event (“Releasees”),
WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or
damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR
OTHERWISE, to the fullest extent permitted by law.

4. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.

5. I, the parent/guardian, assert that I have explained to my child/ward: the risks of the activity, his/her responsibilities for adhering to the rules and regulations, and that my child/ward understands this agreement.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK
AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE
GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND
VOLUNTARILY WITHOUT ANY INDUCEMENT.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*
Date*

MonthDayYear
Date

Emergency Medical Treatment, Consent and Information

The following information will be used in the event that a parent / legal guardian is not available. The purpose of this information is to provide a quick reference for medical
personnel should the need arise. If additional space is needed, please use the back of
this form or attach additional pages as needed. All information disclosed here will be
treated as strictly confidential. It will be the responsibility of the parent/legal
guardian to notify the participant’s coach and league/event officials if any
information needs to be added, deleted, changed, or updated in any way.
Athlete Name*

First NameLast Name
Nickname
First Parent/Guardian Name*

First NameLast Name
First Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
First Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
First Parent/Guardian Email*
example@example.com
Second Parent/Guardian Name

First NameLast Name
Second Parent/Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Second Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Second Parent/Guardian Email
example@example.com
Emergency Contact Name (Other than Above)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Player*
Player's Medical Insurance Provider*
Medical Insurance Policy Number*
Child's Physician Name*

First NameLast Name
Preferred Hospital*
Emergency Medical Information*
Asthema Treatment, Allergies, Conditions, Etc.
I have obtained medical clearance for my child/ward to participate in Freeport Phantoms as described herewith. PLEASE NOTE: If this Medical Clearance is voided by injury, accident, or illness, it will be the responsibility of the Parent/Legal Guardian to notify their child/ward’s Coach. It will also be the responsibility of the Parent / Legal Guardian to obtain WRITTEN permission from medical provider to resume participation.

I as evidenced herewith, I hereby grant permission for my child/ward to participate in any and all, Freeport Phantoms programs and events including but not limited to, athletic, social and/or fundraising activities. I further consent to the administration of any and all medical treatment necessary to stabilize and or treat any medical condition or medical emergency to which my child/ward is afflicted. I understand that this authorization is given prior to the need for medical care, but given in advance to avoid any unnecessary delay in emergency treatment which the attendant and/or medical professional may deem advisable in the exercise of their best judgment.
Parent/Guardian Signature

IMAGE RELEASE WAIVER FOR MINOR PARTICIPANT

My minor child/ward being allowed to participate in any way, in Freeport Phantoms events and activities, the undersigned agrees that Freeport Phantoms is hereby granted the unrestricted right and permission, free from approval or review, to copyright and/or use my child's/ward's likeness in all media now or hereafter known, including but not limited to, pictures and videos of my child which he/she may be included intact or in part for promotion or other commercial use.
Parent/Guardian Signature*
Date*

MonthDayYear
Date
Should be Empty: