Student Football Waiver

STUDENT FOOTBALL WAIVER AND RELEASE OF LIABILITY

Student Information

Date of Birth:    Student ID:    Grade/Program:

Primary Phone:    Email:

Parent / Guardian Information (if student is under 18)

Relationship to Student:    Phone:    Email:

Emergency Contact and Medical Information

Emergency Contact Phone:    Secondary Phone:

Date of Most Recent Physical Examination:    Primary Care Physician:    Physician Phone:

Insurance Information

Policy / ID Number:    Policy Holder Name:

Acknowledgments, Assumption of Risk and Release

I acknowledge that participation in organized football involves inherent risks, including but not limited to serious bodily injury, paralysis, and death resulting from collisions, tackles, falls, heat illness, or equipment failure. I understand that no program can eliminate all risks. By signing, I voluntarily assume full responsibility for all risks associated with participation.

In consideration of the student being permitted to participate in all team activities, practices, and competitions, I, for myself, the student, our heirs, executors and administrators, hereby release, discharge, covenant not to sue and waive liability against the School, its officers, employees, coaches, volunteers, and agents from any and all claims, demands, losses, liabilities, damages, costs and expenses (including attorneys' fees) arising out of or related to the student's participation, including claims for negligence, whether foreseen or unforeseen.

I further agree to indemnify and hold harmless the School and its representatives for any claim brought by or on behalf of the student or a third party arising from the student's acts or omissions while participating in football activities.

Consent to Emergency Medical Treatment

If the student becomes ill or injured, I authorize coaches, athletic trainers, and authorized school personnel to arrange for and consent to emergency medical care, transportation, and treatment as deemed necessary. I understand I will be responsible for all costs not covered by insurance.

I authorize emergency medical treatment as described above.

Concussion and Head Injury Acknowledgment

I acknowledge that I have received information regarding the signs and symptoms of concussions and head injuries. I understand that the student will be removed from play if a concussion is suspected and will not be permitted to return to participation until cleared in writing by a licensed health care professional in accordance with School policy.

I acknowledge receipt of concussion information and the School's concussion management procedures.

Equipment, Conduct, and Team Rules

The student agrees to wear required protective equipment, follow instructions from coaches and trainers, comply with all team and School rules, and report any unsafe conditions or injuries immediately. The School may suspend or remove the student from participation for failure to comply.

I agree that the student will comply with equipment, conduct, and team rules.

Media and Transportation

I grant permission for the student to be transported by School-approved vehicles to and from athletic events. I also consent to the School's use of photographs or video of the student for informational or promotional purposes, unless I opt out below.

I do NOT consent to the use of photographs or video of the student for promotional purposes.

Certification

I certify that the information provided on this Waiver is true and complete to the best of my knowledge. I understand that falsification or omission of material information may void privileges to participate.

I certify the information provided is accurate and complete.

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