Loyola 5th/6th Grade - 2021

Waiver Summary Text: LASD Flag Football Fall 2021 Release & Consent Medical Waiver for Participation After School Athletics Los Altos Flag Football Medical Waiver Parent Permission/Waiver for Participation in Flag Football Request for Permission: I, the below referenced youth athlete’s Parent/Guardian, hereby register my child to participate in the 2021 After School Athletics, Los Altos Flag Football Program. Assumption of Risk: I acknowledge and understand that there is a risk of injury involved in athletic participation. I understand that my child will be under supervision and direction of a youth or parent volunteer coach. I agree to follow the rules for the sport and the instructions of the coaches in order to reduce the risk of injury to my child and other athletes. However, I acknowledge and understand that neither the volunteer coach nor the participating teams we play can eliminate the risk of injury that might occur from my child’s participation in youth athletics and specifically flag football. Release: In consideration of the After School Athletics Los Altos Flag Football Program allowing my child to participate in flag football, I hereby agree to release, waive, discharge, covenant not to sue, hold harmless, and indemnify, on behalf of myself and any other parent or guardian of my child, After School Athletics Los Altos Flag Football Program and their respective volunteer coaches, officials, agents, employees, directors, members, officers and other staff members from liability to us and our child, as well as our personal representatives, assigns, heirs and next of kin, for any and all claims, suits, or causes of action arising from or out of injury, known or unknown, to property or body, that my child may suffer from participation in After School Athletics Los Altos Flag Football Program athletic activities, or the above-described sports activities. Parents are responsible for providing transportation for their child and from league, camp, or other practice sessions. Certification of child participant’s fitness and Medical Authorization. I, the undersigned, hereby certify that to the best of my knowledge, my child is physically fit and able to safely participated in flag football. In addition, I understand that in the case of illness or injury of my child, After School Athletics will try to notify me or the emergency contact listed on the front of this form. In the event of a medical emergency concerning my child at a time when either I or the emergency contact person cannot be notified, I hereby authorize After School Athletics Flag Football Program officials to obtain the necessary medical care and/or treatment for my child, including but not limited to first aid, x-ray examinations, and aesthetic, medical or surgical diagnosis or treatment or hospital care and I hereby accept the sole financial responsibility for such medical care, first aid or treatment. If your child has any allergies, asthmatic conditions or other medical conditions which After School Athletics Los Altos Flag Football Program should be aware of please email our program at gjsorensen@sbcglobal.net. In witness wherof, by clicking the agreed box on this website, or by signing below, I have executed this permission, waiver/release, and Medical Certification form with full knowledge of its contents. By, ___________________________________ Print__________________________________ Date___________________________________