LIABILITY RELEASE - important please read:
I, the undersigned, am the parent or legal guardian of the above-named player, who is under the age of 21 years, and I do hereby consent to the player’s participation in the sport of soccer as a player with EMPOWER SOCCER (a program of Empower North County), and such participation includes but is not limited to all practice sessions, scrimmages and games.
Additionally, I do hereby release and forever discharge said EMPOWER SOCCER from any and all liability whatsoever and from any claim or any action or any claim for relief which may be asserted against said EMPOWER SOCCER or against any individual who is a member of said EMPOWER SOCCER including players as well as adults, by reason of any injury said player may receive or incur while participating in the sport of soccer and said soccer-related activities as set forth above or in the transportation of said player to or from any game or soccer-related activity.
Additionally, I hereby authorize EMPOWER SOCCER personnel to seek emergency medical and/or dental treatment for said player by a Doctor of Medicine or by a doctor of dentistry, so long as they are licensed to practice by any state of the United States, or to seek said treatment by any qualified paramedic or nurse. I agree to pay for said medical and/or dental treatment to the extent that any medical or dental insurance that may cover said player is insufficient.
Finally, I represent to EMPOWER SOCCER that I have, personal medical health insurance that will provide coverage for said player in case any accident or injury should occur relative to any practice, any game or any soccer-related activity. I further understand that having such medical health insurance is an express condition to said player’s participation with EMPOWER SOCCER and that the policy is in force and that such policy shall remain in force while said player is a member of any EMPOWER SOCCER activity or said policy shall be substituted for by another policy. I further agree to inform EMPOWER SOCCER of any changes to the above facts and information as quickly as possible.
I hereby acknowledge that it is my sole obligation to pay whatever expenses may be incurred relative to medical and/or dental treatment for said player to the extent that said family or personal medical insurance is not sufficient.
I hereby acknowledge that I have read all of the foregoing information and that I understand such information and I hereby acknowledge my consent to said player’s participation relative to all foregoing statements, representations and conditions.