Lamorinda Passing League
Participant’s Name: _______________________________________
Birth Date: __________ Grade: ______ School: ____________
Parental & Medical Consent / Release Of Liability
(Please read carefully before signing)
As parent or legal guardian of the above named participant I hereby give my consent for any emergency medical treatment as approved by the facility supervisor in case of injury or sudden illness. My permission is given in order to assure prompt medical treatment in my absence without undue delay. I hereby agree to bear all costs incurred as a result of the foregoing.
I have voluntarily enrolled my child in a program of sports involving activities known to be hazardous. My child and I have chosen to participate with knowledge of the danger involved.
We hereby agree to accept any and all risk of injury or death. As consideration for being permitted by Lamorinda Passing League to have my child participate in the program and use of facilities, I hereby agree that I, my assignees, heirs or agents or my child named above or such child’s assignees, heirs or agents will make no claim against or sue Lamorinda Passing League, its agents, employees or contractors for injury or damage resulting from negligence or other acts, howsoever caused, by any agent, employee or contractor of Lamorinda Passing League or by any spectator or other participant.
I hereby release Lamorinda Passing League, its agents, employees or contractors from all actions, claims or demands that I, my assignees, heirs or agents or my child named above or such child’s assignees, heirs or agents now have or may hereafter have for injury or damage resulting from my child’s participation in the sports program.
I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between me and Lamorinda Passing League and sign it of my own free will.
Authorized Parent/Guardian Name: __________________________
City: __________________ Zip: ______ Home Phone: ___________
Emergency Phone: ________________
Authorized Parent/Guardian Signature:_______________________________Date:_____________