Waiver of Liability, Assumption of Risk, and Emergency Contact




In consideration of being allowed to participate in any way in the Fox River Hurling Club, sporting events, related events and/or activities,

I, _______________________________________________________, acknowledge, appreciate and agree that:
(print name)

1. The risk of serious injury from the activities involved in any and/or all Fox River Hurling Club events is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; AND

2. I knowingly and freely assume all such risks, both known and unknown, and assume full responsibility for my participation; AND

3. I willingly agree to comply with the rules and policies 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

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify and hold Fox River Hurling Club, and its officers, officials, agents and/or employees, other sport participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event or activity (“Releases”) harmless with respect to any and all injury, disability, death, or loss or damage to person or property, 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.


_______________________________________________________, on this date, _____________________
(If participant is under the age of 18, parent/legal guardian signature)

I understand, agree and acknowledge that some activities may be of a hazardous nature and/or include physical and/or strenuous activity. Understanding this, I state that I have no medical condition or impairment that might inhibit my safe and active participation in any Fox River Hurling Club activity. In addition, I understand that the Fox River Hurling Club does not provide medical insurance coverage for activity participants and that any applicable medical insurance must be provided individually by such participants. In the case of injury or medical emergency and in the event participant, or their parent or guardian, does not respond at the time of the emergency, the Fox River Hurling Club has permission to seek, administer, or have administered whatever first aid or emergency medical care deemed necessary for participant’s welfare, and it is understood that participant, and NOT the Fox River Hurling Club, or its officers, officials, agents, or employees, other sport participants, sponsoring agencies, sponsors, advertisers, or, if applicable, owners or lessors of premises used to conduct the event or activity, shall be responsible for any and all charges for such health care services regardless of whether participant’s medical insurance would cover such charges.


_______________________________________________________, on this date, _____________________
(If participant is under the age of 18, parent/legal guardian signature)


_______________________________________________________, ________________________________
(Emergency Contact Name) (Emergency Contact Phone Number)