HIBRITEN/LYSA YOUTH SOCCER CAMP
Camper First and Last Name *
Parent of Camper First and Last Name *
Camper Age *
Camper Birthdate *
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Parent Email *
Parent Phone Number *
Emergency Contact Name *
Emergency Contact Phone Number *
WAIVER
  WAIVER OF LIABILITY AND DISCLAIMER: We, the registrant and the registrant’s parent or guardian, hereby agree and acknowledge the following: (1) We agree to abide by the rules of Lenoir Youth Soccer Association, Hibriten Athletics Department and its affiliated organizations and sponsors. (2)We recognize the inherent risk of serious or permanent physical injury and possible death associated with youth soccer activities and games. In consideration for LYSA accepting the youth player’s registration and participation in its sanctioned youth soccer leagues, tournaments and team travel activities (“Youth Programs”), we hereby release, discharge and/or otherwise indemnify and hold harmless LYSA, Hibriten High School, its affiliated organizations and sponsors, volunteers, their employees and associated personnel, including the owners of fields and facilities utilized for the Youth Programs, against any claim, lawsuit or written demand, including but not limited to any claims for personal or physical injury or death, by or on behalf of the registrant as a result of the registrant’s participation in the Youth Programs and/or being transported to or from the same, which transportation we hereby authorize. (3) We consent to LYSA and Hibriten Athletics taking photographs in documenting the activities of LYSA program and services. We hereby grant LYSA, Hibriten and their affiliate’s permission to use the negatives, digital copies and/or prints or any other reproduction of the same for LYSA and its affiliates educational and promotional purposes in manuals, on flyers, the internet, or other publications. We have read this release and waiver of liability and fully understand its terms. We understand we waive substantial rights by signing this form. We agree to waive all such rights above including the right to file a legal action or assert a claim for personal or physical injury or death of any kind. We Sign this release form freely of our own free will. Legal Authorization for Emergency Care and acknowledgment of Disclaimer.
Person's name acknowledging the waiver *
Date of acknowledgement *
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