PAL0110-101

POLICE ATHLETIC LEAGUE - Waiver/Release Form

Child’s name (print) ______Age ______

I realize that (name of sport) ______is a vigorous physical activity that may involve violent body/ball contact, rapid directional change and rotation, running and various other strenuous activity associated with the sport. I understand that participation in (name of sport) ______involves certain inherent risks and that regardless of the precautions and training taken by the Kokomo Police Athletic League or the participants, some injuries may occur. Common injuries such as falls, bruises, sprained limbs, broken bones, to more serious injuries such as; concussions, blindness, quadriplegia or even death. I also realize my child will be playing in all conditions of weather and I will make them aware of the vehicle traffic in the area.

The likelihood of such injuries may be lessened by adhering to the following:

  1. Attend practices to learn the sport, including proper warm up
  2. Listen to the Coaches instructions
  3. Wear the proper equipment
  4. Know the rules of the game
  5. Inspect the practice and playing field

In order to properly protect my own safety and that of my fellow participants, I agree to follow these rules as well as any others that may be given by my coach/instructor. Further, in recognition of the importance of shared responsibility for safety, I agree to immediately report any noted deviations from the safety rules as well as any observed hazardous conditions or equipment to my coach/instructor.

I further certify that my present level of physical condition is consistent with the demand of active participation in (name of sport) ______. Following is a list of all of my known health conditions that might affect my ability to participate. I have also put the following on my Emergency Information Card for my coach:

I have carefully read the foregoing document. I have had the opportunity to ask questions and have them answered. I am confident that I fully know, understand, and appreciate the risks involved in active participation in (name of sport) ______.

Having been informed of the above program to provide games for girls and boys, I, the parent of the above-named registrant do hereby give my approval of his/her participation in any and all of the activities during the current season. I assume all the risks and hazards incidental to the conduct of the activities, and I do further release, absolve, indemnify, and hold harmless the Police Athletic League, the organizers, sponsors, supervisors, volunteers, and officials, any or all of them. In case of injury to my son/daughter, I hereby waive all claims against the organizers, the sponsors, or any of the supervisors appointed by them. I am voluntarily requesting permission for my son/daughter to participate.

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Signature of parent or guardianDate

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Signature of childDate