Waiver & Emergency Contact Form

Players must fill out this form each season.

Note that you need to be placed onto
a team first, which means that you need to be
in touch with one of the team captains.

In consideration of being allowed to participate in all UPPER VALLEY FLOOR HOCKEY sports programs, events, and activities, 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.
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, or others, and assume full responsibility for my participation.
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual hazard during my presence or participation, I will remove myself from participation.
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS UPPER VALLEY FLOOR HOCKEY, their owners, officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss of damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OF OTHERWISE.
5. I grant permission to be video recorded and photographed in the course of participating in UPPER VALLEY FLOOR HOCKEY games and events and for the photographs to be used in whole or in part without restriction anywhere, in any medium, for any purpose. I release UPPER VALLEY FLOOR HOCKEY from all claims of liability relating to the use of videos or photographs.

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.

I agree to these terms AND I have read the rules

PLAYER INFORMATION



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EMERGENCY CONTACT INFORMATION


Spouse Parent or Guardian Friend Other



After you submit this form, a confirmation will be emailed to you for your records.