Liability Form - Strong High Performance

Player Participant’s Name:

Date of Birth:

Address

Street Address City State / Province / Region ZIP / Postal Code

Player Participant’s Club:

Emergency Contact Information

Father/Guardian Name:

Home Phone:

Cell/Bus Phone:

Mother/Guardian Name:

Home Phone:

Cell/Bus Phone:

Parent/Guardian Address (if different from player participant):

Parent/Guardian Email Address (es):

In case of emergency, when parent/guardian cannot be reached, please contact the following:

Name:

Home Phone:

Cell/Bus Phone:

Medical and Health Information

Player Participant’s Allergies and Other Medical Conditions:

Physician:

Phone:

Hospital/Clinic:

Medical Insurance Company:

Policy Holder's Name:

Policy #:

Agreement

This Release and Waiver of Liability, Assumption of Risk, Consent, and Indemnity Agreement (the “ Agreement”) must be read and signed before the undersigned, or player participant, attends or participates in any tournament, game, activity or other event (the “Event”) sponsored, governed or operated by Strong High Performance Soccer LLC (SHPS) This Agreement is signed in consideration of the opportunity to play or participate in the Event as governed by Texas Law.

1. Physical and Medical Status: I am physically fit and have no medical condition that will prevent me from safely and fully participating in the Sports Teams or that will be aggravated by my participation. I will inform my coach if this status changes.

2. Acceptance of Risk: I am aware and understand that participating in soccer training and tournaments involve the risk of injury. I voluntarily choose to participate in SHPS with a full awareness and a complete acceptance of all of the risks, hazards, and dangers associated with participating in Sports Teams. I further acknowledge that these risks, hazards, and dangers may involve loss or damage to me or my property, including the risk of death, or other unforeseen consequences, including those which may be due to the unavailability of immediate emergency medical care. Subject to all insurance coverages that may be available to me from any source, and only with respect to Spirit League and its officers, directors, employees, and volunteers, I fully assume all risks of injury, illness, and death resulting from and associated with participating in SHPS.

3. Insurance Coverage: I further understand that SHPS may not carry insurance coverage that will apply in the event of my death, injury, illness, or damage to my property that may occur during my participation in the Sports Teams. I acknowledge that SHPS recommends that I purchase insurance to cover my participation in the training program and if I want such insurance coverage it is my sole responsibility to purchase it. In any event, I agree to bear responsibility for any medical expenses I may incur that result from my participation in SHPS (including but not limited to training, practices, games, and travel to and from these events).

4. Release: I, intending to be legally bound hereby, for myself, my heirs, my executors, and my legal representatives, fully release, discharge, and acquit Strong High Performance Soccer LLC and all of its officers, directors, employees, and volunteers from any and all liabilities, actions, causes of actions, claims, expenses, and damages, including attorney’s fees, on account of any and all injuries to my person or property, even injury resulting in death, that may arise from my participation in the Sports Teams.

As further consideration, I hereby agree, represent, and warrant that the matters released herein are not limited to matters that are known or disclosed

5. Waiver, Covenant not to Sue, Indemnification, Defend, and Hold Harmless: I, intending to be legally bound hereby, for myself, my heirs, my executors, and my legal representatives, agree to waive any liability, covenant not to sue, fully indemnify, defend, and hold harmless Strong High Performance Soccer LLC and its officers, directors, employes, and volunteers from any liability incurred in the conduct of, and my participation in SHPS.

6. Media Rights: I understand and am aware that SHPS may take photographs, make audiovisual recordings, and create other works that include my name, image, voice and/or likeness (collectively, “Media”) in connection with SHPS. I hereby agree that SHPS owns all Media and has the unrestricted right to use the Media in any and all mediums including but not limited to print, television, radio, and Internet, for any and all purposes, including use by third parties with whom SHPS may engage in joint activities, with no remuneration or compensation to me. I hereby assign, without limitation, to Strong High Performance Soccer LLC all right, title, and interest I may have in or to any Media. Also, I hereby release, discharge, and acquit SHPS from any claims, demands, or causes of action that I may have against Strong High Performance Soccer LLC - whether for libel, violation of right of privacy, or anything else - by reason of the use of my name, image, likeness, or voice in connection with the Media or any publicity pertaining to the Media.

7. Choice of Law and Severability. I expressly agree that this Agreement is to be interpreted under Texas law, will be as broad and inclusive as permitted under Texas law, and that if any portion of this Agreement is invalid or unenforceable, all other portions will continue in full legal force and effect. I further expressly agree and intend; for myself, my heirs, my executors, and my legal representatives, to be bound by the terms of this Agreement.

• I certify I have completely and carefully read this Agreement, fully understand its contents, and agree to be bound by each of its terms.

• I acknowledge that I have given up substantial rights by entering this Agreement and that I do so voluntarily.

• I understand this Agreement will legally prevent me or any other person from filing a lawsuit or making any other legal claim from damages in the event of my injury or death that result my participation in Strong High Performance Soccer LLC.

• My signature attests to this Agreement on behalf of myself and my executors, personal representatives, administrators, heirs, next-of-kin, successors, and assigns.

Participant’s signature:

Date:

Participant’s name:

Age/Birth date:

IF PARTICIPANT IS UNDER 18 YEARS OF AGE, A PARENT OR LEGAL GUARDIAN MUST SIGN BELOW

• I certify that I am the Participant’s parent or legal guardian.

• Participant has my full consent and permission without reservation to participate in the Strong High Performance Soccer LLC according to the each of the terms contained in this Agreement.

• I certify that I have carefully read and understand and that I agree to be bound by each of the terms contained in this Agreement with respect to any claims that I and/or the Participant may have.

• I represent and certify that I have the legal capacity and the authority to act for, and on behalf of, the minor in the execution of this Agreement.

Parent’s signature:

Date:

Parent’s name:

Telephone: