After practices and games, does participant have your permission to sign themselves out and return home unassisted?
If no, list any other adults who have permission to sign out participant
Permission Waiver: As a parent or legal guardian of the minor listed on this form, I give permission for him/her to participate in Kensington Soccer Club (KSC). I understand that this permission includes my permission for my child to participate in all KSC activities. I understand that KSC assumes no responsibility for seeing to it that the minor reports to activities at the KSC sponsored program, and I, on my own behalf and on the behalf of this minor, waive all claims for any liability arising or actions occurring before the minor has reported to KSC programs. I give permission to KSC to collect and record data about my child for program evaluation purposes. I give permission to KSC to periodically survey my child for feedback and program evaluation purposes. I understand that all information obtained will remain private, and that any responses publicly reported will be grouped together with other participants. My child's identity shall be kept completely confidential when reporting. I also give my permission for KSC to provide transportation for my child to scheduled practices, games, tournaments, and other field trips.
Liability Release: I, the parent/guardian of the minor, agree that I and the minor will abide by the rules of KSC and its affiliated organizations and sponsors. My child has received a physical examination and has been found physically capable of participating in the KSC program. Recognizing the possibility of physical injury associated with soccer and physical activity and in consideration for KSC accepting minors for its program, I assume all risks and hazards incidental to athletic participation and hereby release, discharge, and/or otherwise indemnify KSC, its officers, directors, coaches, sponsors, volunteers, agents, and affiliates, against any claim by or on behalf of the minor as a result of the minor's participation in the KSC program.
Consent for Medical Treatment of Minor: In the event of a medical emergency, I hereby authorize the adult representatives of KSC to make any necessery arrangements for the proper medical care of the participating minor. I understand that I will be notified as soon as possible in the event that an emergency arises requiring medical assistance and I assume all financial responsibility for any medical treatment including transportation for my child.
Media Release: In consideration of the opportunity to participate in the KSC program, I hereby give permission to KSC, its employees, affiliates, representatives, contractors, agents, and members of the media to interview, audiotape, videotape, film, or capture by any other electronic means my child's image, voice, and likeness, and, within its absolute discretion, to release, disseminate, or use, in any manner KSC sees fit including publications and web pages, the resulting images and testimonials and any other information contained therein for the purpose of demonstrating, advertizing, and promoting the objectives of KSC. I understand that my child and I shall receive no compensation for his/her appearance on or participation in the KSC prgram. As parent/guardian of minor, I hereby assign to KSC, all rights, including copyright, in any works created in whole or part by the minor while participating in the KSC program.
I grant my child permission to participate in the KSC program and can demonstrate that my child is without any physical conditions that would prevent my child from engaging in physical activities.
Please write your full name below as an electronic signature to indicate your approval.