Waiver Form and Release of Liability For
Eastern
North Carolina Pop Warner Youth Football Conference and Newport
Pop Warner Football and Cheerleading Association
DISCLAIEMER:
Eastern North Carolina Pop Warner Youth Football Conference and Newport
Pop Warner Football and Cheerleading Association
are not responsible for any injury (or loss of property) to any person suffered
while participating or in any other way involved in the 2007 Football &
Cheerleading Season for any reason whatsoever, including ordinary negligence on
the part of Eastern North Carolina Pop
Warner Youth Football Conference and Newport Pop Warner Football and
Cheerleading Association , its agents or employees.
In consideration of my participation, I hereby release and covenant not
to sue Eastern North Carolina Pop Warner
Youth Football Conference and Newport Pop Warner Football and Cheerleading
Association ,
Board of Education, and any of employee, instructor, or agent/assignee of
any of the above three named agencies from any and all present and future claims
resulting from ordinary negligence on the part of Eastern
North Carolina Pop Warner Youth Football Conference and Newport Pop Warner
Football and Cheerleading Association ,
or others listed for property damage, personal injury or wrongful death, arising
as a result of my engaging in or receiving instruction while participating in
the 2007 Football & Cheerleading Season activities incidental thereto,
wherever, whenever or however the same may occur.
I hereby voluntarily waive any and all claims resulting from ordinary
negligence, both present and future, that may be made by me, my family estate,
heirs, or assignees.
Further,
I understand that football & cheerleading are vigorous team sports involving
severe cardiovascular stress and physical contact.
I understand that football & cheerleading involve certain risks,
including but not limited to, death, serious neck and spinal injuries resulting
in complete or partial paralysis, brain damage and serious injury to all bones,
joints, muscles and internal organs. I
further understand that football & cheerleading involve a high risk of knee
and ankle in injuries. In addition,
I understand that participation in the 2007 football & cheerleading season
involves activities incidental thereto, including but not limited to, travel to
and from the site of the activity, participation at sites that may be remote
from available medical assistance and the possible reckless conduct of other
participants. I am voluntarily
participating in this activity with knowledge of the danger involved and hereby
agree to accept any and all inherent risks of property damage, personal injury
or death.
I
further agree to indemnify and hold harmless Eastern
North Carolina Pop Warner Youth Football Conference and Newport Pop Warner
Football and Cheerleading Association and
others listed for any and all claims arising as a result of my engaging in or
participating in the "2007 Youth Football & Cheerleading Season"
activities incidental thereto, wherever, whenever or however the same may occur.
I
understand that this waiver is intended to be as broad and inclusive as
permitted by the laws of North Carolina, and agree that if any portion is held
invalid, the remainder of the waiver will continue in
full
legal force and effect. I further
agree that the venue for any legal proceeding shall be in North Carolina.
I
affirm that I am of legal age and am freely signing this agreement.
I have read this form and fully understand that by signing this form, I
am giving up legal rights and/or remedies which may be available to me for
ordinary negligence of Eastern North
Carolina Pop Warner Youth Football Conference and Newport Pop Warner Football and Cheerleading Association
or any of the parties listed above.
In
case of a medical emergency arises while participating in the programs,
permission is given for staff personnel, including coaches or their designates
to seek medical help. Permission is
given to physicians to perform needed treatment.
The department agrees to contact you as soon as possible, if the medical
emergency involves your minor child. If
we cannot contact you, we should contact
_______________________________
at _______________________(phone number).
I
hereby give Eastern North Carolina Pop Warner Youth Football Conference and
Newport Pop Warner Football and Cheerleading Association permission to film and
or display my child’s picture on their official website. I also understand
that my child’s name and or address will not be disclosed
Parent or Legal Guardian's Signature___________________________________Date____________________