Parent/Guardian Consent For Participation & Photo, and Release of Liability
Parent/Guardian Consent For Participation & Photo, and Release of LiabilityI/We, the undersigned, being the parent(s) or legal guardian(s) of________________________________, do hereby grant permission for his/herparticipation in One Y.A.R.D’s leagues/tournaments, and release One Y.A.R.D. and their agents from all causes of legal action, damages, and claims orinequity of any kind whatsoever from any illness injury or loss resulting from ___________________________’s participation in One Y.A.R.D. sponsoredsports, programs or activities. Said activities may include, but are not necessarily limited to the sports of soccer, street hockey, basketball, and programactivities involving visual arts, music or the performing arts. I/We also hereby give consent and release, without recompense, for the use ofphotographs, recordings or videotape which may include _______________________________, taken for the purpose of One Y.A.R.D. publicity,publications, promotions, or news media coverage of One Y.A.R.D. activities. I/We also hereby agree that I/we and____________________________will abide by the safe orderly and effective operation of One Y.A.R.D. sports programs and activities, and understand that failure to so abide may result intermination of ____________________________________’s participation in One Y.A.R.D.-sponsored sports, programs or activities at the sole discretionof One Y.A.R.D. or its agents.Authorization to Consent to Treatment of Minor In the event of injury in the course of participation in One Y.A.R.D. sports, programs or activities, I/We, the undersigned being the parent(s) or legalguardian(s) of ___________________________ do hereby authorize the One Y.A.R.D. or its agents, acting as agent for the undersigned to consent toany triage, X-ray, examination, medication or anesthetic, medical or surgical diagnosis or treatment, emergency dental care, and related hospital care for___________________________________as may be deemed urgent and/or immediately advisable by, and is either rendered under the general orspecific supervision of a physician, dentist or surgeon licensed under the provisions of the Medicine Practice Act or State of California-certifiedemergency first response personnel, whether such diagnosis is rendered at the office of said physicians, at a hospital, or in the field by licensedemergency first responder personnel. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital carebeing provided, but is given to provide authority for the One Y.A.R.D. or its agent(s) to give specific consent to any and all urgent medical care which theaforementioned physician, dentist, surgeon or emergency first response personnel in the exercise of his/her/their best professional judgment may deemadvisable at time of or following injury. This authorization is given pursuant to the provisions of Section 258 of the California Civil Code and shall remainin effect for as long as________________________________ participates in One Y.A.R.D. sports programs or activities, unless revoked sooner inwriting and personally delivered to the One Y.A.R.D. or its agents. It is also understood that failure to give or revocation of said authorization willnecessarily result in the inability to participate and termination of participation from One Y.A.R.D. sports programs and activities inasmuch as the OneY.A.R.D. will be effectively constrained from seeking prompt medical attention for the above named minor in the event of injury.Signature(s) of Parent/Guardian______________________________________ Date___________________
