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Contra Costa FC (CCFC) Participation Waiver

This form must be completed for each soccer player (participant) and, if a player is under 18 years of age, must be signed by the player’s parent or legal guardian. No player will be allowed to participate in any matches (“trainings”, “practices”,“games” and “clinics”) without this form properly executed, and on file with Contra Costa FC (“CCFC”).

In signing this waiver I am acknowledging that my participation is entirely voluntary. I also acknowledge that participating involves risk of injury or illness, including but not limited to COVID-19. As a condition of participating I agree to hold harmless and covenant not to sue Contra Costa FC, Atletico East Bay, LSE BRANDS LLC, the Directors and Officers, Coaches, Trainers of any and all associated LSE BRANDS LLC entities.

In signing this waiver I also acknowledge that I have both read the CCFC COVID-19 Release of Liability and Safety Protocols and Return to Competition Guidelines, and will abide by the release of liability and those safety protocols.

I, the undersigned, in consideration for my voluntary participation in CCFC matches do hereby willfully acknowledge that my signature below attests to my understanding and agreement that:

Soccer is a physical contact sport that involves the risk of injury. I assume all risks and hazards associated with my participation in CCFC matches. I am in proper physical condition to participate in CCFC matches, and have no illness, including but not limited to COVID-19, disease or existing injury or physical defect that would be aggravated by my participation or would put others participating at risk. I will inform my coach or trainer if this status changes.

I further acknowledge that participation may involve loss or damage to me or my property, injury including the risk of death, or other unforeseen consequences, including those which may be due to the unavailability of immediate emergency care. I will wear proper protective equipment including shin guards, protective headwear, appropriate shoes and will wear a mask when not involved in a match environment.

I understand that I should have current, active, personal injury insurance policy in force, which covers my participation. Under any condition, I am responsible for any and all medical expenses arising from my participation, and while traveling from and to these matches. I have the right and responsibility to inspect the equipment and facilities prior to any matches and, if I believe that anything may be unsafe I will advise my coach of the condition and may refuse to participate. Participation assumes consent and assumptions of all risks.

I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation to a medical treatment facility should an individual listed above consider it to be warranted.

I grant to CCFC the right to take photographs and/or videos in connection with CCFC activities. I authorize CCFC, its assigns, and transferees to copyright, use and publish the same in print and/or electronically.

I agree that CCFC may use such photographs and/or videos with or without their name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, and Web content.

I hereby release, waive liability, discharge, hold harmless, indemnify and covenant not to sue Contra Costa FC, Atletico East Bay, LSE BRANDS LLC, the Directors and Officers, Coaches, Trainers of any and all associated LSE BRANDS LLC entities from any and all liability occurred in the conduct of and my participation in any CCFC matches. I have completely read this document and fully understand its contents. I acknowledge that I have given up substantial rights by accepting and executing this document and that I do so voluntarily. My signature attests to this on behalf of myself and my executors, personal representatives, administrators, heirs and assigns.

Dated: October 24, 2021

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Most Recent Club

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First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Most Recent Club

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Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Most Recent Club

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Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Most Recent Club

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Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Most Recent Club

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Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Most Recent Club

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Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Most Recent Club

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Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Most Recent Club

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Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Most Recent Club

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Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Most Recent Club

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Parent or Guardian's Email Address

Email*

Confirm Email*
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Club
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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 Most Recent Club

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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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