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Field Hockey Life LLC
2020-2021

In the consideration of Field Hockey Life LLC acceptance as a participant in sports for the period of dates mentioned above, and in return for the opportunity to participate in a Field Hockey Life LLC program:

I understand that a risk of participating in any sport, including Field Hockey Life LLC, is the risk of injury, including but not limited to serious permanent injury, COVID-19 exposure, paralysis, and death. To minimize the risk of injury, I agree to tell my child to obey all safety rules and to report fully any problems related to their physical condition or health concerns to the coaches as soon as the problem begins.

By signing this waiver, I certify the following:

  • That my child is not currently under the care of a physician for an injury or illness that would prevent their safe participation in the program.
  • That my child is not currently being treated for or recovering from an orthopedic injury that would prevent their safe participation in the program.
  • That my child has no history of fainting or other problems related to strenuous exercise.
  • That my child is in good health and there is no reason that she cannot safely participate in strenuous physical activity.
  • That my child will adhere to all necessary COVID-19 protocol.

In accepting my child into Field Hockey Life LLC, I do hereby agree that I am and shall be responsible for all costs associated with any injury or loss that may be sustained by my child as a result of their participation in the program. I also certify that I have health insurance which provides adequate coverage for injuries or illness my child may sustain while participating in Field Hockey Life LLC.

By my signature below, I also agree to release and promise not to sue Field Hockey Life LLC or their staff for any damages, loss, injury, or death arising from my child’s participation in Field Hockey Life LLC, unless such damages, loss, injury, or death are caused by willful and wanted conduct of such employees.

Today's Date: September 28, 2021

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
Tenth Participant's Date of Birth*
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*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
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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