University of Okoboji Soccer Tournament Medical Release and Liability Waiver

Player Name ("Athlete")*

First NameLast Name

Division/Team*

Parent/Guardian Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Emergency Contact (in case parents or guardian cannot be reached in time of emergency)*

First NameLast Name

Home Phone Number*

Area CodePhone Number

Mobile Phone Number*

Area CodePhone Number

Date of Athlete's Last Tetanus Booster*

List any allergies of the Athlete, including any allergies to medicine:*

List Athlete's health conditions that should be noted:*

Athlete's primary health care provider*

First NameLast Name

Health Care Provider's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Health Care Provider's Phone Number*

Area CodePhone Number

Insurance Provider*

Policy #*

I agree to the following:*

I affirm that Athlete meets all eligibility requirements for participation in the Tournament as made available at bojisoccer.com.I affirm that I have read the Spectator Code of Conduct available at bojisoccer.com and agree that I, my Athlete, and all guests who accompany me and my Athlete to the Tournament will abide by such code of Conduct.

Informed Consent Waiver and Acknowledgement

I, the undersigned, as the parent or guardian of the above named Athlete, in consideration for Athlete’s voluntary participation in the University of Okoboji Soccer Tournament (“Tournament”), hereby willfully acknowledge that my signature below attests to my understanding and agreement that:

Soccer is a physical, contact sport that involves the risk of injury. I assume all risks and hazards associated with Athlete’s participation in the sport. Athlete is in proper physical condition to participate in soccer games and has no illness, disease or existing injury or physical defect that would be aggravated by Athlete’s participation. I further acknowledge that this risk may involve loss or damage to Athlete or Athlete’s property, including the risk of death, or other unforeseen consequences, including those which may be due to the unavailability of immediate emergency medical care. I hereby authorize the tournament staff including training staff present at the tournament, if any, to act according to their best judgment in any emergency requiring medical attention.

I maintain on behalf of Athlete that Athlete has a current, active, personal injury insurance policy in force, which covers Athlete’s participation. Under any condition, I am responsible for any and all medical expenses arising from Athlete’s participation in, and travel to and from the tournament. I have the right and responsibility to inspect the equipment and facilities prior to events and, if I believe that anything may be unsafe, I will advise Athlete’s coach or tournament official supervisor of the condition and Athlete may refuse to participate. Participation assumes consent.

I, as the parent or guardian of Athlete, hereby authorize Athlete’s photograph, picture or likeness, and voice to appear in any documentary, promotion (including advertising), television, video, or radio coverage of the tournament, without compensation.

To the fullest extent permitted by law, by signing this release form, I hereby (a) assume any and all risk of loss, injury, or damage to person or property, whether anticipated or unanticipated, arising directly or indirectly from soccer activities related to the Tournament, and (b) forever waive, release, discharge, and covenant not to sue, and agree to indemnify, defend, and hold harmless, Boji Soccer Classic, its affiliates, supporting organizations, Board of Directors, officers, agents, employees, and volunteers (collectively, the "BSC Indemnitees") from any and all claims, demands, losses, injuries, or damages of any kind or nature (including attorney's fees) and however caused that may occur directly or indirectly as a result of, or arising out of, the Tournament or travel to and from the Tournament, except if solely caused by the BSC Indemnitees' willful misconduct or gross negligence. Except as expressly set forth in this release, Boji Soccer Classic makes no other representations or warranties, express or implied. The provisions of this paragraph shall survive expiration or termination of this release.

This agreement shall be governed by the laws of the State of Nebraska without regard to its conflicts of laws principles.

Informed Consent Waiver and Acknowledgement*

I affirm that I have read, understand, and agree to the above Informed Consent Waiver and Acknowledgement.

As the parent and natural guardian or legal guardian of the participant, I hereby agree to the foregoing Medical Release Form and Waiver of Liability for, and on behalf of, the Athlete named above. I hereby bind myself, the minor, and all other assigns to the terms of the Waiver of Liability and Release. I represent and certify that I have the legal capacity and the authority to act for, and on behalf of, the minor in the execution of this Waiver of Liability and Release. By typing your name below, you agree that you have read, answered honestly, and agree to all above information. Failure to sign this waiver will result in Athlete's disqualification from the tournament without a refund*

Name of Parent/Guardian

Date*

Date