RELEASE FORM

Hooked-On-Hockey 

Spring* Summer* Fall* Programs

Director: South Coast Coach Susan Fontaine

Email: Coachsfon@gmail.com



Participant Name:________________________

Grade:____ Years Played:____

School:__________________________

Jersey Ladies Cut: S  M  L  XL  XXL

E-mail Address:___________________________

In Case of Emergency

Parent/Guardian_______________________

Contact numbers:_________________________

Medical Alert:____________________________

Insurance Co and Policy #__________________

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                                         League Requirements:

1. Release form filled out and signed

2. Safety Precautions followed during participation.

*All sports have certain risk to them.  The listed safety precautions are mandatory and each parent or guardian will be responsible for their child following them.

Participants over 18 will be responsible for themselves.

Safety Precautions:

1. Wearing a mouth guard and shin guards and other safety gear during participation.

2. Staying hydrated with water or sports drinks, etc. during participation. 

3. Removing all jewelry before participation.

4. Cooperating with director, volunteers, officials, and teammates. 

It is highly recommended that the parent or guardian that provided transportation for the player(s) to the game >>> remains on site.

HOLD HARMLESS RELEASE FORM

In consideration of being allowed to participate in any of the Hooked-On-Hockey programs, related events and activities, the undersigned acknowledges, appreciates and agrees that:

1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, and assume full responsibility for my participation; and, 

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Hooked-On-Hockey and any or all affiliated or subsidiary entities, their officers, officials, agents, and/or employees, other participants, volunteers, sponsors, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property; and,

5. In the event that a claim is brought by Participant or Releasee against the other, the defendant shall be able to recover reasonable attorneys’ fees if incurred in successfully defending against such claim. 

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. 

FOR PARTICIPANTS OF MINORITY AGE (Under 18)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above. 

Parent/Guardian Signature______________________________________2017

PARTICIPANT (over 18):__________________________________2017