The undersigned parent and/or legal guardian of the above-named minor, hereby consents to the full participation by the above-named minor in the Mid-State Youth Football League (Mid-State) and the local league/community.
I acknowledge that the activities that my child will be involved in may be dangerous in nature and I represent that I know and understand those dangers to which my child will be exposed. I specifically acknowledge and understand that football/cheerleading is a collision sport with potential risk of serious injury or even death.
I do hereby voluntarily assume on behalf of the above-named minor each, every, and all risks and/or hazards to which said minor or myself might be exposed during Mid-State activities including, but not limited to, playing said sport, cheerleading and/or transportation to and from all activities, and medical attention of any nature resulting from injuries sustained in the activities. Also, I do hereby Waive, Release, Absolve and Agree to Indemnify Pay and Hold Harmless said football/cheerleading program, it’s entire organization, Mid-State, the local league/community, their coaches, participants, Board of Directors, all officers, all assistants, persons and/or organizations that transport the participants for any purpose for and from all claims, injuries, damages of both a compensatory and punitive nature and for any and all other claims and/or damages which may arise out of and/or due to the above mentioned minor’s participation in said activities.
The parent/guardian whose signature appears below does hereby consent to any and all medical treatments including anesthesia and operations which may be deemed necessary by medical care providers attending to the above-named minor for injuries sustained in the activities.
I further agree and acknowledge that I am responsible for all charges incurred in connection with treatment and care rendered to the above-named minor pursuant to this agreement.
I further agree to the following:
- It will be the responsibility of the parent/guardian to ensure that all player football equipment furnished to your child be returned to the local league no later than December 1, of the current season year. Failure to do so shall result in the parent/guardian to be charged a replacement fee for all equipment not returned.
- If I, as a parent/guardian have an issue, I will first address it with the involved head coach independently of a game or practice. If needed, that parent/guardian can request a joint conference with the involved head coach and the local league director of football.
- Furthermore, I agree to encourage good sportsmanship at all times, pledge to support all participants, including teammates and opponents, coaches, and referees; demonstrate a positive attitude towards Mid-State; demand a healthy environment free of alcohol and drugs; agree to calmly seek solutions to any problems, refraining from confrontations in front of other children; and agree to contribute to providing an environment that ensures that all participants have a fun, safe, and enjoyable experience.
In signing this form, I also give Mid-State, as well as the local league/community, permission to use the minor child’s photograph as a participant on either organizations website or other promotional products.