Camp at Kiski Waiver - Futbol Goals USA

Registration confirmed! But you must fill out the necessary waiver(s) prior to arriving to this camp at Kiski.

Confirmation emails have been sent to the “Billing Email” provided to us on your registration.
If your card has been charged by us, then we have your information and registration logged.
If you can’t find your confirmation email, please email us at admin@futbolgoals.us and we will resend it to the billing email on file. In the meantime, please fill out the waivers as needed.

Futbol Goals USA Official Camp Waiver

Parent/Legal Guardian Release Form
Email

A copy of this signed waiver will be sent to this email address.
Player First Name*
Player Last Name*
Date of Birth

MM/DD/YYYY
Sex*
Parent Names*
Phone Numbers*
I, the player’s parent/legal guardian, understand the nature of camp activities, certify that the player is able to participate in the program, and grant permission for said participation. I agree to assume and take on myself all of the risks and responsibilities in any way arising from or associated with this Camp. On behalf of myself, my child, our assignors, executors and heirs, I hereby release, discharge, covenant not to sue, and agree to indemnify and hold harmless Futbol Goals USA, LLC( “Releasees”), its owners, officers, agents and employees from any and all liability, damage and claims of any nature arising from or in any way related to my child’s participation in this program. I release ‘Releasees ’ from any and all claims, demands, suits, judgments, damages, actions and liabilities of every name and nature whatsoever, whenever occurring, whether known or unknown, contingent or fixed, at law or in equity, that my son may suffer at any time arising from or in connection with the Activity, including any injury or harm, my son’s death, or damage to my property (collectively “Liabilities”), and I agree to defend, indemnify, and save ‘Releasees’ harmless from and against any and all Liabilities.
Release Form Parent Signature*
Date of Above Parent/Legal Guardian Release Form Signature
***PLEASE NOTE WE WILL HAVE A DIGITAL THERMOMETER AT THE FIELD AND YOU WILL BE REQUIRED TO HAVE YOUR TEMPERATURE CHECKED AT THE FIELD BEFORE PARTICIPATING***
Medical / Emergency / Insurance Information
Medical and Emergency Information In anticipation of my child’s participation in the camp program, I certify that I have consulted with my child’s physician and that my child has been medically cleared for camp-related activity. I agree that I am financially responsible for any and all medical expenses associated with my child’s participation in this program. I understand that my child will not be allowed to participate in this program without medical insurance coverage as documented below.LLC( “Releasees”), its owners, officers, agents and employees from any and all liability, damage and claims of any nature arising from or in any way related to my child’s participation in this program. I release ‘Releasees ’ from any and all claims, demands, suits, judgments, damages, actions and liabilities of every name and nature whatsoever, whenever occurring, whether known or unknown, contingent or fixed, at law or in equity, that my son may suffer at any time arising from or in connection with the Activity, including any injury or harm, my son’s death, or damage to my property (collectively “Liabilities”), and I agree to defend, indemnify, and save ‘Releasees’ harmless from and against any and all Liabilities.
Insurance Provider*
Policy #*
Policy Holders Name*
Date of last tetanus shot*
List any and all medications*
Does your child need clinic staff to store and/or dispense medication?*
- Yes
- No
If yes, please provide specific instructions
List any medical condition or history that would require special attention ( e.g., medication or food allergies, asthma, diabetes, epilepsy); also, please provide treatment protocol (e.g., inhaler, Epipen,insulin):
Emergency Treatment/Pick Up Form
Primary Emergency Contact Name & Phone (Include area code)
Secondary Emergency Contact Name & Phone (Include area code)
Parent/Guardian Signature*
Date of above Parent/Guardian Signature
Persons Permitted to Retrieve Child
Please let us know if there are special arrangements or restrictions for early dismissal or retrieving your child during the combine. Name of the person or persons to whom we may release your child:
If player needs to be released at any time other than the end of clinic please specify date and time here:
Date for Early Dismissal / Retrieval
MM slash DD slash YYYY
Time
Additional Documents Info
Documents can be emailed to admin@futbolgoals.us separately
Waiver/Release for Communicable Diseases including COVID-19
FUTBOL GOALS USA WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19

ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT
In consideration of being allowed to participate on behalf of Futbol Goals USA Soccer ID Camps and related events and activities, the undersigned acknowledges, appreciates, and agrees that:

1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and,
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; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or 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 Futbol Goals USA, 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 (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, 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 IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
Name of participant*
Participant Signature*
Date of Participant Signature Above
FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)

This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.
Name of Parent/Guardian*
Parent Guardian/Signature
Date of Above Parent/Guardian Signature
MM slash DD slash YYYY
Waiver/Release for Kiski Camp
Kiskiminetas Spring School
1888 Brett Lane, Saltsburg, PA 15681
Phone: 724.639.3586

IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER (Kiski) FOR ANY PURPOSE, INCLUDING BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY PROGRAM AFFILIATED WITH (Kiski), WITHOUT RESPECT TO LOCATION, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:

1. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the (Kiski), its directors, officers, employees, and agents (hereinafter referred to as “releasees”) from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefor on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned is in, upon, or about the premises or any facilities or equipment therein, or participating in any program affiliated with the (Kiski), without respect to location.

2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in, upon, or about the (Kiski) premises or in any way observing or using any facilities or equipment of the (Kiski) or participating in any program affiliated with the(Kiski) whether caused by the negligence of the releasees or otherwise.

3. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE due to negligence of releasees or otherwise while in, about, or upon the premises of the (Kiski) and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the (Kiski). THE UNDERSIGNED further expressly agrees that the forgoing RELEASE, WAIVER AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of (Pennsylvania) and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statements, or inducement apart from the foregoing written agreement have been made.
Name of Parent/Guardian*
Parent/Guardian Signature
Date of Kiski Waiver Signature
MM slash DD slash YYYY

Registration confirmed! But you must fill out the necessary waiver(s) prior to arriving to this camp at Kiski.

Futbol Goals USA Official Camp Waiver

Parent/Legal Guardian Release Form

Medical / Emergency / Insurance Information

Emergency Treatment/Pick Up Form

Waiver/Release for Communicable Diseases including COVID-19

FUTBOL GOALS USA WAIVER/RELEASE FOR COMMUNICABLE DISEASES INCLUDING COVID-19

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)

Waiver/Release for Kiski Camp

Terms of Service

Privacy Policy