Dodgeball Waiver

Division

Grades 3-4
Grades 5-6
Grades 7-8
High School (if under 18 years of age)

Team Name

Name of Participating Youth*

First Last

Please provide the following information and sign as indicated in each section below.

1. DECLARATION OF LEGAL CUSTODY*

I certify that I have legal custody of and responsibility for my child who is participating in the SchoolPower DodgeBall Tournament. I further certify that – if I have joint custody of this minor – I have notified the other parent or responsible party of his/her participation in the program.

Parent/Guardian Signature*

Name*

First Last

2. PERMISSION TO TREAT*

Should it be necessary for my child to have medical treatment while participating in the SchoolPower DodgeBall Tournament, I give my permission to the SchoolPower staff to seek emergency treatment for my child.

Parent/Guardian Signature:*

3. PERMISSION TO PHOTOGRAPH*

I understand that activities at the SchoolPower Dodgeball Tournament will be photographed or videotaped, including but not limited to a team photo of each team which my child can choose to be in. I give my permission for these photos/videos of my child to be used in publicity (e.g., social media, newsletters, website, newspaper) without compensation.

Parent/Guardian Signature:*

4. WAIVER AND HOLD HARMLESS*

Every effort is made to provide participants with a safe, enjoyable, and memorable experience. I attest and verify that my child is physically able to participate in all activities offered at the SchoolPower DodgeBall Tournament. I understand, however, that there are inherent risks in participating in an indoor DodgeBall Tournament, and, knowing the risks, nevertheless, I agree to ASSUME ALL RISKS OF PERSONAL INJURY, PERMANENT, TEMPORARY, TOTAL OR PARTIAL DISABILITY, DISFIGUREMENT, PARALYSIS AND ANY OTHER LOSSES OR DAMAGE TO PERSON OR PROPERTY OR DEATH, sustained while my child participates in, attends, prepares for or travels to and from the SchoolPower DodgeBall Tournament, including the risk of negligence of the SchoolPower and/or Laguna Beach Unified School District staff, or hidden, latent or obvious defects in the facilities or equipment used.

I agree if any claim for personal injury or wrongful death is commenced against SchoolPower and/or Laguna Beach Unified School District (including its officers, directors, members and/or volunteers), I will defend, indemnify and hold harmless SchoolPower and/or Laguna Beach Unified School District from any and all claims or causes of action for personal injuries, property damage or wrongful death that hereafter accrue, arise out of, result from, or are caused directly or indirectly by my child’s attendance at the SchoolPower DodgeBall Tournament.

I have read and I understand this Waiver and Hold Harmless provision.

Parent/Guardian Signature*

Date*

Name*

First Last

Address*

Street Address City State Zip

Phone*

Email*

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Dodgeball Waiver