SMM First Touch Elite Soccer Academy at Augustana College Registration

The following information should be filled out by the person who carries the medical insurance on the participant:

Medical information for the participant:

My son/daughter has permission to engage in the programs and activities at SMM First Touch Elite Soccert Academy. In the event of an urgent medical matter, if I cannot be reached, I hereby give permission to the SMM First Touch Soccer Academy official and/or his/her designee to secure and authorize in my absence any and all medical treatment he/she deems necessary, including but not limited to Emergency Department treatment, laboratory tests, radiological tests/procedures, intravenous fluids, medications, physician services, and/or surgical procedures, for my child named above. In addition, I give my permission for the SMM First Touch Elite Soccert Academy official and/or his/her designee to exchange information regarding my child’s medical history and current medical/health status with the physician and medical facility staff.

 MEDICAL WAIVER 

This form provides important information about the SMM First Touch Elite Soccert Academy, during the months of June through August and taking place on the campus of Augustana College in Rock Island, Illinois.

As a student of the Program (a “Participant”), and as a parent/legal guardian of a Participant, it is important that you read this Agreement carefully and be aware that by signing this Waiver and Release of All Claims and participating in the Program, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you might sustain as a result of any and all activities connected with and associated with the Program.

1. 1. Voluntary Participation: I wish to participate in the Program. I am not being forced in any way to take part in this Program.
   2. Assumption of Risks of Program: I understand that participation in the Program may involve inherent risks and I am also aware that hazards may exist which may be marked or unmarked and occur without warning, and that monitoring and enforcement of the rules by SMM First Touch Elite Soccert Academy does not and cannot guarantee the safety of the Participants. The risks of the Program include, but are not limited to:
      • Local health and weather conditions
      • Injury resulting in serious, permanent physical injury, or even death, resulting from accident, natural disasters or acts of God, from strikes, ware, quarantine or government restrictions, from medical care of treatment received or from the lack of medical services.
      • Potential of criminal or injurious acts by others
      • Physical exertion or emotional distress
      • Exposure to infectious, communicable and other diseases
      • Exposure to allergens, whether known or unknown
      • Loss of valuable property
   3. I acknowledge that not every risk or possibility can be foreseen, and that the omission of a risk does not in any way limit the enforceability of this agreement. KNOWING THE RISKS DESCRIBED ABOVE AND OTHER POTENTIAL RISKS NOT LISTED HERE, AND IN CONSIDERATION OF BEING ALLOWED TO PARTICIPATE IN THE PROGRAM, I HEREBY ASSUME ALL RISKS AND RESPONSIBILITIES SURROUNDING MY PARTICIPATION IN THE PROGRAM, OR MY WARD/CHILD’S PARTICIPATION IN THE PROGRAM.
   4. Waiver, Release and Indemnification: I AGREE TO RELEASE, INDEMNIFY AND HOLD HARMLESS SMM First Touch Elite Soccert Academy ITS OFFICERS, DIRECTORS, TRUSTEES, AGENTS, AND EMPLOYEES (“RELEASES”) FROM ANY AND ALL LIABILITIES, CLAIMS, OR DEMANDS OF ANY NATURE WHATSOEVER, FOR PERSONAL INJURY, PROPERTY DAMAGE OR OTHER LOSS OF ANY KIND THAT I MAY SUSTAIN, AND THAT MY WARD/CHILD MAY SUSTAIN, AS A DIRECT OR INDIRECT RESULT OF PARTICIPATION IN THE PROGRAM, EVEN IF SUCH LOSS RESULTS FROM THE NEGLIGENCE OF THE RELEASEES (EXCEPT FOR CLAIMS OR LIABILITY ARISING DIRECTLY FROM THE GROSS NEGLIGENCE OF RELEASEES). I UNDERSTAND THAT BY SIGNING THIS DOCUMENT, I AM GIVING UP MY LEGAL RIGHT TO SUE TO RECOVER DAMAGES FOR CLAIMS THAT I MIGHT HAVE.
   5. Insurance: I understand that all Participants are required to carry accident and medical insurance.
   6. Standards of Conduct: I understand that Participants are responsible for their own conduct. I agree to comply with all the rules, regulations and policies of SMM First Touch Elite Soccert Academy, including those (if any) specifically pertaining to the Program.
   7. Valuables: I understand that I am solely responsible for keeping safe any money, jewelry and other property. SMM First Touch Elite Soccert Academy, the Program Director(s) and/or other employees and agents acting on its behalf are in no way responsible for safeguarding any of my personal belongings.
   8. Program Changes and Refunds: I understand that SMM First Touch Elite Soccert Academy reserves the right to make changes to the Program. I also understand that Programs may be cancelled. Participants of cancelled Programs will receive a full refund upon program cancellation. Refunds will be made within a timely manner.
   9. Withdrawal: I understand that if I withdraw from the Program for any reason (after the payment deadline date), or if I am involuntarily dismissed from the Program based on my conduct, I will receive no refund.
   10. Medical Treatment Authorization: SMM First Touch Elite Soccert Academy, its officers, directors, trustees, agents, and employees, is authorized (but not obligated) to take any action (including notification of my parents or guardian) it considers to be warranted under the circumstances regarding my health and safety. I agree to reimburse SMM First Touch Elite Soccert Academy for all expenses related thereto and hereby release SMM First Touch Elite Soccert Academy, its officers, directors, trustees, agents and employees, from any and all liability for such actions and/or for payment for such authorized treatment.
   11. Photo Release: I grant permission to SMM First Touch Elite Soccert Academy to photograph me and to use those images in any printed or electronic media. I understand that the photographs will be the property of SMM First Touch Elite Soccert Academy and that I will not be notified when the photographs are used, nor will I have the opportunity to view and approve the photographs prior to their publication.
   12. Binding Effect; Construction: Forum: I acknowledge that this agreement will bind members of my family, my spouse, heirs, assigns and personal representative(s). This agreement will be construed under the law of the State of Illinois, which will be the forum for any lawsuits filed under or incident to this agreement or to the Program. Should any part of this agreement be rendered or declared invalid by a court of competent jurisdiction, such invalidation or such part or portion of this agreement should not invalidate the remaining portions thereof, and they shall remain in full force and effect.