THIS AUTHORIZATION FOR MEDICAL TREATMENT MUST BE COMPLETED BEFORE A PLAYER/YOUTH REFEREE BEGINS PARTICIPATION. TREATMENT FOR INJURY WILL BE BASED ON LS-FORMATION PROVIDED HEREIN.
I the undersigned (if applicant/participant is 18 years of age or older) or paren / guardian of the above listed minor applicant/participant acknowledge and fully understand that each applicant/participant will be engaging in activities that involve risk or serious injury, including permanent disability or death, and severe social and economic losses which might result not only from their own actions, inaction or negligence, but action, inaction or negligence of others, the rules of play, or the conditions of the premises or of any equipment used and further, that there may be other unknown risks not reasonably foreseeable at this time. assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death. hereby release, discharge, covenants to indemnify and not to sue Chicago Sockers — Nike Classic Cup Tournament, it's atliliated organizations and sponsors. their coaches, managers, employees and associated personnel, officers, director, agcnks, including the owners and leasers of premises used to conduct this event, all of which arc herein referred to as "releasees" from any and all liability to each of the undersigned, his/her heirs or next of kin for any and all against any claim buy or on behalf of the applicant as a result of the applicant's participation in the Pmgrams and/or being transported to or from the same, which participation, after careful consideration I hereby authorize, and which transportation I hereby authorize. This applicant/participant has receivedd a physical examination by a physician and has been found physically capable of participating in the Program. I hereby give my consent to have an athletic trainer, coach and/or doctor or medicine or dentistry or associated personnel to provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. 1, also agree to save and hold harmless and indemnify each and all parties referred to above as release from all liability, lose, cost, claim or damage whatsoever, including death or damage to property. which may be imposed upon said release because of any defect in or lack of such capacity to so act or caused or alleged to be caused in whole or in part by the signing of this release. I have also read the above waivethelease and understand that I havegiven' up substantial rights by signing this release and sign below voluntarily.