Liability & Press Release

BE SURE TO COMPLETE THE FOLLOWING

WAIVER OF LIABILITY, INDEMNIFICATION, ASSUMPTION OF THE RISK, AUTHORIZATION TO CONTACT EMERGENCY MEDICAL ASSISTANCE and PRESS RELEASE FORM

Athlete's Full Name

Athlete's Date of birth

Athlete's Age

THIS “WAIVER OF LIABILITY, INDEMNIFICATION, ASSUMPTION OF THE RISK, AUTHORIZATION TO CONTACT EMERGENCY

MEDICAL ASSISTANCE and PRESS RELEASE FORM” (“Form”) HAS BEEN APPROVED BY Eastside Colts., for use at all activities held by its members.

If you are over the age of 18, you are releasing legal rights for yourself by initialing and executing this form.

READ IT CAREFULLY.

If the participant is under the age of 18, as a parent or legal guardian you are releasing rights for yourself and for your child by initialing and executing this form.

READ IT CAREFULLY.

Parent/Guardian's Full Name

Parent's Phone Number

Insurance Carrier

Policy Number

Athlete has NO INSURANCE