Moms Give a Puck

Please print off this form and bring it with you the day of the tournament. 

WAIVER AND RELEASE OF LIABILITY
In consideration of being allowed to participate in any way in the MOMS GIVE A PUCK 3 ON 3 Youth
Hockey Tournament in support of Sick Kids, the undersigned acknowledges, appreciates, and agrees
that:
1. The risk of injury from the activities involved in this program 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, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my participation; and,
3. I willingly agree to 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,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS, MOMS GIVE A PUCK, their officers, officials, agents, and or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and !lessors of premises used to conduct the event (“Releases”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

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.

______________________________________
PARTICIPANT’S SIGNATURE



_______________________________________ Date Signed: ________________________________


WITNESS



 


FOR PARTICIPANTS OF MINORITY AGE
(UNDER 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and
agree to his/her release as provided above of all the Releases, and, for myself, my heirs, assigns, and
next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor
child’s involvement in this tournament as provided above.


_______________________________________   ______________________________________
PARENT/GUARDIAN’S SIGNATURE          EMERGENCY PHONE NUMBER



_______________________________________ Date Signed: ________________________________
WITNESS