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Rockford Park District - Mercyhealth Sportscores

The Rockford Park District is committed to conducting its recreation programs and activities in a safe manner and holds the safety of participants in high regard. The Rockford Park District continually strives to reduce such risks and insists that all participants follow safety rules and instructions that are designed to protect the participants’ safety. However, participants and parents/guardians of minors registering for this program must recognize that there is an inherent risk of injury when choosing to participate in recreational programs/activities.

You are solely responsible for determining if you or your minor child/ward are physically fit and/or adequately skilled for the activities contemplated by this agreement. It is always advisable, especially if the participant is pregnant, disabled in any way or recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity.

WARNING OF RISK

Softball is intended to challenge and engage the physical, mental and emotional resources of each participant. Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury. All hazards and dangers cannot be foreseen. Certain risks include, but are not limited to, the acts of pitching, throwing, fielding and catching the ball, the swinging of the bat, being struck by errant balls, being struck by another player’s bat, running, jumping, stretching, sliding, diving, collisions with other players and with stationary objects, acts of God, inclement weather, horseplay, unsportsmanlike conduct, dangerous playing conditions, poor field conditions, defective equipment, equipment failure, premises defects, slip and falls, failure in supervision and officiating, and all other circumstances inherent to sport of softball. In this regard, it is impossible for the Rockford Park District to guarantee absolute safety. 

This includes any possible exposure to and illness from infectious diseases including, but not limited to MRSA, influenza and Covid-19.. I acknowledge if I have ahd a diagnosis  of or sympthoms consistant with any  infectious  disease within 14 days before any sanctioned event, than I will not participate until I have been cleared by an appriopriate medical profession.

WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK

Please read this form carefully and be aware that in signing up and participating in this program/activity, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this program/activity (including transportation services and vehicle operations, when provided).

I recognize and acknowledge that there are certain risks of physical injury to participants in this program/activity, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in this program/activity against the Rockford Park District, including its officials, agents, volunteers and employees.

MEDICAL RELEASE:  In the event of an emergency, I authorize officials of the Rockford Park District to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my immediate care, and agree that I will be responsible for payment of any and all medical services rendered.  Participation will be denied if the signature of adult participant is not on this waiver.

I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. If registering on-line or via fax, my on-line or facsimile signature shall substitute for and have the same legal effect as an original form signature.

First Player's Name

First Name*

Last Name*

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

Team Name *
First Player's Signature*
Second Player's Name

First Name*

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

Team Name *
Third Player's Name

First Name*

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

Team Name *
Fourth Player's Name

First Name*

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

Team Name *
Fifth Player's Name

First Name*

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

Team Name *
Sixth Player's Name

First Name*

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

Team Name *
Seventh Player's Name

First Name*

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

Team Name *
Eighth Player's Name

First Name*

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

Team Name *
Ninth Player's Name

First Name*

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

Team Name *
Tenth Player's Name

First Name*

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

Team Name *
Player'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.
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*

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

Team 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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