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IB Online Waiver & Medical Release

Required for all coaches and participants

Important:

1-When entering your team name you must include the team year & coaches initials.

Example: Utah Arrows '09 RH

2-Once Completed, you must forward your email waiver verification to your team manager as they are required to submit these with their rosters at team check-in. 

US Utah Comp Soccer, LLC Tournament(s) (USUCS, LLC)
Ice Breaker Soccer Tournament  (IBST)

AMATEUR ATHLETIC WAIVER AND MEDICAL RELEASE

This Waiver and release must be filled out and agreed to by the parent or legal guardian of the said participant(s).

Note: Please do not provide personal contact information for any child 13 and under (i.e.: cell phone numbers, email addresses etc.).

In consideration of participant being permitted to participate in the IBST and USUCS Sponsored Tournaments Sanctioned by the United States Specialty Sports Association (USSSA):

1-As a participant or parent/guardian of said participant you certify that the participant is in good health and capable of participating in a high physical activity sport. It is understood that soccer and related activities are inherently dangerous and that participants will be engaging in strenuous physical activities that may involve risk of serious injury, permanent disability, severe social or economic loss or death. You further acknowledge that injury or loss may result from you or other’s actions, inactions, or negligence. As a participant (legal guardian representing the participant) you accept and agree to assume all risk(s) to body, life, limb, and property as well as all financial liabilities that may be incurred during USUCS, LLC Tournament(s). This will include travel to and from the event. 

Trainers/Emergency Medical Personnel/Medical Insurance

2-You acknowledge that there may not be certified or professional trainers or medical personnel available during the event or at your field location. AED medical devices will not be available.

-In the event that a participant sustains injury or illness while participating in a USUCS, LLC or IBST(s) You must call 911 in case of accident, emergency, or medical condition. Should medical attention be needed and provided you agree to authorize emergency first aid, medication, surgery, or any type of medical treatment necessary by qualified and or licensed medical personnel to sustain the health, life, and limb of said participant. The tournament will not be liable for the cost of the attending medical personnel or the medical service they provide. Any trainer or medical personnel will be responsible for their own service, actions, and or treatment. It is understood and agreed that you use them on the condition that the sponsored tournament/event will not be held responsible or liable for their actions, inactions or fees related to the service they provide. 

-If you are a participant or spectator in a USUCS, LLC sponsored Tournament(s), individual players and their families must obtain and provide their own insurance and or an accident policy which will cover the participant and or spectator(s) should they be injured or receive harm in any way while playing or observing in the IBST or other sponsored USUCS, LLC tournament(s). You certify that each player registered is covered by an approved medical plan provided by the participant’s legal guardians. Individual players and or their parents/guardians assume all risk and liability. 

-Please report any such injuries/treatment to the tournament within a timely manner. You acknowledge that it is not the responsibility of the referees, field monitors, athletic trainers, emergency first responders or any other individual. The parent or guardian is to report any such injuries within a reasonable time to the tournament. 
Phone/text: 801-232-1111 Email: icebreakersoccer@gmail.com 

3- Participant(s) or legal guardian(s) of a minor participant agrees that prior to participating in each game; that you will inspect the field/facilities and equipment to be used. If you believe anything to be unsafe (i.e.: field conditions, goals, weather conditions etc.) you will immediately advise your coach and the attending field monitor, referee or tournament administrators of such condition(s) and refuse to participate.

Please report any dangerous conditions or an accident/incident to:
Text or call 801-232-1111, 801-784-1091
E-mail: icebreakersoccer@gmail.com

4-You certify that participants and parent/legal guardian have read the rules, regulations and code of conduct of USUCS, LLC and agree to abide by them. This includes city and school district policies, rules and procedures which will be posted on the sponsored tournament web site: www.usucs.com 

5-You acknowledge and agree to release, indemnify, and to hold harmless USUCS, LLC & the IBST and its subsidiaries, tournament hosts, officials, sponsors, coaches, referees, landowners, cities, schools/school districts and/or representatives from any claim(s) arising from any participant(s), coach or spectator attending or participating in said event. 

6-USUCS, LLC and the IBST is held in February during the winter months and that playing conditions may be wet, snowy or cold and that playing fields may be dormant. You acknowledge and agree to play on field conditions that may be less than desirable and that conditions will vary from location to location.

7-COVID-19 Acknowledgement and Agreement 
Should this event be affected by Covid-19 or any other pandemic situation, this event is allowed to proceed on the condition that we follow the prescribed city, state and health department guidelines and mandates. All participants and spectators agree to follow the guidelines and mandates (if any) that may be required or expected from the local city, state, or health department. 

-Refunds are not available for any reason including but not limited to COVID/pandemic or other related issues, cancelations or any other situation that may arise. 

8-As a participant/spectator in one of the USUCS, LLC & IBST Sponsored and USSSA Sanctioned Tournaments you agree to give consent and allow your image, voice, or likeness thereof to appear in any official documentary, promotion or media coverage through the use of television, radio, web/internet, film or other media coverage related to the tournament or promotion thereof.

9-You agree that this Waiver, Release and Agreement is considered to be a legal and binding document and is intended to be as broad and inclusive as is permitted by law. This Wavier, Release and Agreement must be renewed annually for authorized and continued participation of USUCS, LLC and the IBST sponsored events. If any provision of this Waiver, Agreement and Release shall be found unlawful or for any reason deemed unenforceable, then that particular provision shall be deemed severable from this Wavier, Release and Agreement and shall not affect the validly and enforceability of any of the remaining provisions contained therein. In such circumstances/situations you hereby agree that the liability and financial responsibility first and for most falls upon the individual (parent/guardian) and their personal resources, next their own insurance policy (as required by this agreement), and finally their team, club, group, or association to which they belong and its policies.

10-Due to the enormous amount of planning and preparation you acknowledge and understand that USUCS, LLC and the IBST have a strict no refund policy for any reason once a team has registered and paid their entry fees. You also acknowledge that USUCS, LLC, The IBST and its affiliate members and administrators cannot be held responsible or liable for situations and circumstances beyond their control which may include but are not limited to acts of god (weather/snow/rain, tornado's, earthquakes, floods and or other natural disasters), civil unrest, war, pandemics or other unforeseen circumstances. 

St. George, Washington, Hurricane, La Verkin and the Washington County School District have implemented policies that under certain conditions such as rain or snow that may compromise or ruin their city parks and school fields, that all games will be cancelled, and the tournament will not be allowed to proceed.

If we are unable to finish the tournament with PK’s at the mark the tournament will be terminated and cancelled. It is understood that USUCS, LLC & IBST is not able to offer refunds in such circumstances and will not be responsible for any inconvenience or economic loss that may be incurred. Please refer to the contingency plan listed at www.usucs.com under tournament rules. In some instances, a credit may be offered (but is not guaranteed) for another time, tournament or event given at the sole discretion of the tournament. 

11-You agree to submit this Waiver, Release and Agreement via electronic signature in order to participate in the said sporting event. You acknowledge and agree that this must be filled out and submitted by you as the legal and authorized individual agent, parent, or legal guardian and that you will not allow or permit any other person or individual to act in your behalf accept as legally permissible. At the time of this signing, you may print out a copy of this Waiver, Release and Agreement. You may also see a copy at www.usucs.com or request a copy at any time from icebreakersoccer@gmail.com. 

By indicating your acceptance of this Agreement, Waiver and Release, you acknowledge that you have read and understand this document and that you fully understand the terms and conditions contained therein. You understand that you are giving up substantial rights including the right to sue and that you do this voluntarily of your own free will and choice. This Waiver, Release and Agreement is intended to be a complete and unconditional release of all liability to the greatest possible extent allowed by law. 

By signing this electronic waiver, the participant and/or legal guardian of the participant acknowledge that they understand and accept the terms and conditions stated in this waiver and release and that it will be recognized as a legal and binding document.

 

 

First Participants Name

First Name*

Last Name*

Phone*
First Participants Date of Birth*
First Participants Information

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
First Participants Signature*
Second Participants Name

First Name*

Last Name*
Second Participants Date of Birth*
Second Participants Information

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Third Participants Name

First Name*

Last Name*
Third Participants Date of Birth*
Third Participants Information

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Fourth Participants Name

First Name*

Last Name*
Fourth Participants Date of Birth*
Fourth Participants Information

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Fifth Participants Name

First Name*

Last Name*
Fifth Participants Date of Birth*
Fifth Participants Information

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Sixth Participants Name

First Name*

Last Name*
Sixth Participants Date of Birth*
Sixth Participants Information

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Seventh Participants Name

First Name*

Last Name*
Seventh Participants Date of Birth*
Seventh Participants Information

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Eighth Participants Name

First Name*

Last Name*
Eighth Participants Date of Birth*
Eighth Participants Information

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Ninth Participants Name

First Name*

Last Name*
Ninth Participants Date of Birth*
Ninth Participants Information

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Tenth Participants Name

First Name*

Last Name*
Tenth Participants Date of Birth*
Tenth Participants Information

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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