Player information, Medical Release, Liability Waiver/Release, Media/Photo Release and Consent Form

*To be retained by CRSC for at least five (5) years or until the player's 18th birthday, whichever occurs last

Primary Contact

By signing below, you acknowledge that you have read and agree to all of the terms below. I acknowledge that soccer or any sporting event is an extreme test of a person's physical and mental limits and that my participation in a sports event can cause serious injury, property damage, or even death. There are certain inherent risks associated with participating in sports, either as an athlete or spectator, which 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, contracting a virus or disease, including COVID-19, loss of sight, joint injuries, back injuries, heart attacks, concussions, paralysis, and even death. Please contact the Centers for Disease Control (the CDC), your state and/or local governments for the most up-to-date information and guidance as it relates to COVID-19 and other health concerns. With a full understanding of the potential risks, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN ARISING FROM THE NEGLIGENCE OF THE NAMED PERSONS OR ENTITIES listed or others, and assume full responsibility for the listed player participation. I hereby take the following action for the listed player, myself, my executors, administrators, heirs next of kin, successors, and assigns: I WAIVE, RELEASE, AND DISCHARGE from any and all claims or liabilities for death or personal injury or damages of any kind which arise out of or relate to traveling to and from or participation in any sports practice, tournament, game, or event involvingCoal Region Soccer Club. I AGREE NOT TO SUE any of the named persons or entities listed herein for any of the claims or liabilities that I, the player listed, have waived, released, or discharged herein. I INDEMNIFY AND HOLD HARMLESS the named persons or entities listed here for any of the claims made or liabilities assessed against them as a result of my actions or listed player actions. NAMED PERSONS OR ENTITIES: Coal Region Soccer Club, its owners, directors, managers, coaches, assistant coaches, chaperones, any venue where we practice or play, any tournament directors, sponsors, and the owners, officers, directors, employees, subcontractors, representatives, and agents of any of the above entities. The Participant acknowledges to Coal Region Soccer Club that the Participant does not have any physical limitations, medical ailments, or physical or mental disabilities that would limit or prevent the Participant from participating in events with Coal Region Soccer Club. If required, the Participant will obtain a medical examination and clearance. By signing this waiver, I acknowledge that even if Coal Region Soccer Club and/or any of their affiliates, directors, officers, officials, employees, agents, or volunteers use reasonable care in providing this activity, there is a chance I or the listed player may be seriously injured or killed by participating in this activity because there are certain dangers inherent in the activity which cannot be avoided or eliminated. By signing this waiver, I am giving up my right and the right of the listed player to recover from Coal Region Soccer Club, and/or any of their affiliates, directors, officers, officials, employees, agents, or volunteers in a lawsuit for any personal injury, including death, to myself or any property damage that results from the risks that are a natural part of the activity or due illness including COVID-19. I hereby bind myself and all other assignees to the terms of this waiver. I represent that I have the legal capacity and authority to act for and on behalf of myself, and I agree to indemnify and hold harmless the named persons or entities named in.

By signing below I acknowledge that I have read and agree to all terms listed above and that I have provided a signature below or provided electronic consent.

I hereby grant permission to Coal Region Soccer Club to photograph and/or record videos of my image, likeness, or depiction. By signing below or providing electronic consent, I hereby grant permission to Coal Region Soccer Club to edit, crop, or retouch such photographs or videos, and waive any right to inspect the final photographs or videos. I hereby consent to and permit photographs and/or videos of myself to be used by Coal Region Soccer Club worldwide for any purpose, including educational and advertisement purposes, and in any medium, including print and electronic, and social media. I understand and agree that Coal Region Soccer Club may use such photographs and/or videos with or without associating names thereto. I further waive any claim for compensation of any kind for Coal Region Soccer Club use or publication of photographs and/or videos of myself. I hereby fully and forever discharge and release Coal Region Soccer Club and their affiliates, officers or members from any claim for damages of any kind (including, but not limited to, invasion of privacy; defamation; false light or misappropriation of name, likeness or image) arising out of the use or publication of photographs or videos of myself by Coal Region Soccer Club and covenant and agree not to sue or otherwise initiate legal proceedings against Coal Region Soccer Club for such use or publication. All grants of permission and consent, and all covenants, agreements, and understandings contained herein are irrevocable. I acknowledge and represent that I am over the age of 18, have read this entire document, that I understand and agree to its terms and provisions, and that I have provided a signature below or provided electronic consent.