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DMFSP Facility Waiver - 4618 West Ridge RD. Spencerport, NY 14559

DMFSP CLUB RELEASE

The undersigned represents the Organization and its players, who will be participating in sports at the premises known as Doug Miller Family Sports Park (K&K Property Ventures LLC) located at 4618 Ridge Road W, a facility operated by Doug Miller Soccer (“DMS”).  In consideration of being allowed to be on the premises of DMFSP/DMS for these purposes and on behalf of the Organization agrees as follows:

(a)        The Organization represents that they have registered their players with NYSWYSA and have had each player sign a liability release holding K&K Property Ventures LLC, DMFSP & Doug Miller 19INC/DMS harmless against any and all injuries and recognizes and acknowledges that his/her participation in such activities involves the exposure to inherent risks and potential injury. 

(b)        With full knowledge of the above and any other risks associated with sports participation, the Organization hereby expressly and specifically assumes said risks, and agrees to waive any and all claims for personal injury, illness, death or property damage of any kind on behalf of myself, my heirs, personal representatives and/or next-of-kin which may arise against K&K Property Ventures LLC, DMFSP/DMS.

(c)        The Organization expressly understands and agrees that this Release is intended to be as broad and inclusive as permitted by law and that this Release shall be governed by and interpreted in accordance with the laws of the State of New York. 

(d)       I have read this Waiver and Release carefully and understand all of its terms, and agree to be bound hereby.

I Agree

I hereby warrant that my child/players are in good physical condition and is capable of participating in this program. I hereby waiver and release Doug Miller 19 Inc. d/b/a Doug Miller Soccer, its staff, K&K Property Ventures LLC, Doug Miller Faimly Sports Park, and all affiliates from any and all liability for any injuries and illness' incurred during participation at Doug Miller Family Sports Park. Each participant will be responsible for any and all costs of medical attention and treatment. Doug Miller 19 Inc. d/b/a Doug Miller Soccer, Doug Miller Family Sports Park is not responsible for personal items that are lost, stolen or damaged.

I have read this Waiver and Release carefully and understand all of its terms, and agree to be bound hereby.

I Agree

I give permission for K&K Property Ventures LLC, DMFSP, Doug Miller Soccer (Doug Miller 19, inc.) to make use of pictures of my son/daughter for informational/advertising purposes only.  I request no identifiable information pertaining to the above-named person(s) be used in conjunction with the photograph, slide, audiotape or videotape.  I hereby release Doug Miller Soccer and all of its affiliated entities, including its employees and volunteers for any and all liability for any damages suffered as a result of or relating to the use of any photograph, slide, videotape or audiotape of my child done in accordance with the foregoing.

I Agree

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Club or School *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Club or School *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Club or School *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Club or School *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Club or School *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Club or School *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Club or School *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Club or School *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Club or School *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Club or School *
Parent or Guardian's Email Address

Email*

Confirm Email*
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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.
Parent or Guardian's Name

First Name*

Last Name*

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

Club or School *
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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