Palo Alto Field Hockey Club - BAFHA Waiver Form

Team name:
Member’s name:
Last: ___________________________________
First __________________________ Initial _______
Address:
Street _____________________________________
City ______________________________________State _____________________________ Zip ________
Contact Info:
Home Phone: _____________________________ Work Phone: _________________________
Email: ___________________________________
Participation:
Player: ________	Umpire: _________	Non-playing Member: ________________

In consideration of being allowed to participate in any way in the Bay Area Field Hockey Association programs, related events and activities, the undersigned acknowledges, appreciates arid willingly agrees that:

1. I will comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately: and, 2. I acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which may result not only from their own actions, inactions or negligence but the action, inaction or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, I accept personal responsibility for the damages following such injury, permanent disability or death; and, 3. I knowingly and freely assume all such risk, both known and unknown even those arising from the negligent acts or omissions of others, and assume full responsibility for my participation: and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, hold harmless the Bay Area Field Hockey Association, its officers, officials, affiliated clubs, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, advertisers, and, if applicable owners and lessors of premises used to conduct the event, all of which are hereinafter referred to as "releasees" with respect to all and any injury, disability, death or loss or damage to person or property, whether arising from the negligence of the releasees or otherwise, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT