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IB 2019 Online Waiver & Medical Release

US Utah Comp Soccer, LLC Tournament(s)
(Ice Breaker Waiver & Release)

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

 In consideration of participant being permitted to participate in US Utah Comp Soccer, LLC Sponsored Tournaments:

1- Participant(s) or legal guardian(s) of a minor participant agrees that prior to participating in each game; you will inspect the facilities and equipment to be used. If you believe anything to be unsafe, you will immediately advise your coach and the attending field monitor of such condition(s) and refuse to participate. 

2-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, sever social or economic loss or death. You further acknowledge that injury or loss may result from you or others actions, inactions or negligence. As a participant (or legal guardian of 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 incur during US Utah Comp Soccer, LLC Tournament(s) including travel to and from the event. 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 at or in the Ice Breaker or other sponsored USUCS, LLC tournament(s). Individual players and or their parents/guardians assume all risk and liability.

3- You certify that participants and parent/legal guardian have read the rules and regulations of US Utah Comp Soccer, LLC found at www.usucs.com and or in the tournament program (if available) and agree to abide by them. You acknowledge and agree to release, indemnify, and to hold harmless US Utah Comp Soccer, LLC & the Ice Breaker Soccer Tournament and its subsidiaries, tournament hosts, officials, sponsors, coaches, referees, land owners and/or representatives from any claim(s) arising from any participants in this event. You also certify that each player registered is covered by an approved medical plan provided by the participant’s legal guardians and said guardian assumes all risk and liability on and off the field of play for participation in US Utah Comp Soccer, LLC and the Ice Breaker sponsored Tournament(s).
 
4-In the event that a participant sustains injury or illness while participating in a US Utah Comp Soccer, LLC or Ice Breaker  Sponsored Tournament(s) You acknowledge that medical personnel will not be readily available and agree that it is the parent or guardian responsibility of the said participant to call 911 for emergency help. Should medical attention be needed you agree to authorize emergency first aid, medication, surgery or any type of medical treatment necessary by qualified licensed medical personnel to sustain the health, life and limb of said participant. Furthermore you acknowledge that it is not the responsibility of the referees, field monitors, athletic trainers, emergency first responders or any other individual but the parent or guardian to seek or report any such injuries within a reasonable time to the tournament icebreakersoccer@gmail.com or call/text 801-232-1111.


5-Parents and or guardians acknowledge and agree to participate accepting full responsibility knowing that US Utah Comp Soccer, LLC and the Ice Breaker Soccer Tournament is held in February during the winter months and that playing fields may be dormant, that field conditions may be less than desirable and that conditions will vary from location to location.

6-As a participant in one of the US Utah Comp Soccer, LLC & Ice Breaker Soccer Sponsored and 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, film or other media coverage.

7-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 US Utah Comp Soccer and the Ice Breaker 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.


8-Due to the enormous amount of planning and preparation you acknowledge and understand that US Utah Comp Soccer, LLC and the Ice Breaker Soccer Tournament have a strict no refund policy for any reason once a team has registered and paid their entry fees. Please refer to the contingency plan listed at www.usucs.com under tournament rules. In some instances a credit may be offered for another time, tournament or use at the Utah Sports Lodge given at the sole discretion of the tournament director.   

9-You agree to submit this Waiver, Release and Agreement via electronic signature and that it will be considered legal and binding. 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 singing 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 Waiver, Release and Agreement 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 volition. 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 Participant's Name

First Name*

Last Name*

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

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
First Participant's Signature*
Second Participant's Name

First Name*

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

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Third Participant's Name

First Name*

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

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Fourth Participant's Name

First Name*

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

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Fifth Participant's Name

First Name*

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

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Sixth Participant's Name

First Name*

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

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Seventh Participant's Name

First Name*

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

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Eighth Participant's Name

First Name*

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

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Ninth Participant's Name

First Name*

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

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Tenth Participant's Name

First Name*

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

Team Name *

Team Age (example: 01, 08) *

Coaches Name *
Participant's 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

Emergency Contact's 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.
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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