INDY ELEVEN/EVOLVE EDUCATION CENTER

SOCCER CLINIC

Evolve Education Center in Indianapolis, Ind. |  3202 E. 42nd Street

Friday, June 16, 2023

9:00 a.m.-1:00 p.m.

Boys Only  |  Ages 6-14

Registration Fee: $0

Note: Your privacy is very important to us. To better serve you, the form information you enter is recorded in real time.

Age of Participant (Birth Year)*
What age group is the participant in?
Name of Participant*
Gender*
Name of Parent/Guardian*
Address*
How did you hear about this event?*

WAIVER AND RELEASE FORM

 

Assumption of Risk, Waiver of Liability, and Indemnification Agreement

Nature of the Activity: The United Soccer League (hereafter referred to as USL) is a professional soccer league consisting of a number of Teams in numerous states. The USL and individual Teams conduct many activities that involve participation by parties who are not employed by the teams or the league. Some of these activities include, but are not limited to, team tryouts, halftime activities at games, team promotional events, special events, soccer clinics, and soccer camps. In this document, these activities will be referred to collectively as USL Activities. Some of these involve participation in soccer-related activities such as games, drills, skill or fitness tests, conditioning, and soccer instruction. These activities involve vigorous physical activity and, like all physical activity, carry with them the inherent risk of injury. Some of those inherent risks are being hit in the head or face with a ball; collisions with other participants or stationary objects (such as the goals); goals overturning and striking a participant; over-exertion by a participant; heat-related illness; and unexpected extreme weather (such as lightning, tornado, high winds). Some activities may include fun games and contests, competition between attendees, and activities with which the participant is unfamiliar – all of which have inherent risks. Participants can be over-enthusiastic and be injured while caught up in the spirit of the event and trip, fall, or suffer other mishaps. Other inherent risks in all USL Activities include unexpected equipment failure; failure of safety equipment to protect; erratic or careless behavior of the participant; erratic or careless behavior of other participants; supervisory or judgment error by USL (or Team) staff, coach, instructor, referee (e.g., coach, instructor, or referee misjudging the capacity of the participant to perform an action; failure of the instructor, coach, or referee to see or recognize dangerous actions or situations, failure to spot a hazard during facility inspection).

USL/Team feels that it is important that that the ADULT PARTICIPANT [OR MINOR PARTICIPANT AND PARENT(S) OR GUARDIAN(S)] (hereafter referred to as PARTICIPANT/PARENT) need to be aware that three types of injury can occur as a result of USL Activities. Most common are  minor injuries, which include, but are not limited to, bruises, cuts, scratches, minor sprains, muscle pulls, muscle soreness, and headaches. Occasionally, a participant suffers a  major injury, which includes, but is not limited to, eye injuries, broken bones, joint injuries (e.g., fractures, dislocations), internal organ injury, severe sprains, and concussions. And finally, while rare, there is the possibility of a catastrophic injury, which includes, but is not limited to, spinal injuries, injuries resulting in permanent disability, paralysis, heart attack, stroke, brain injury, and death.

Assumption of Inherent Risks:  I, the PARTICIPANT/PARENT, have read the above paragraphs and know that USL Activities contain inherent risks which are impossible to prevent. I understand the nature and demands of USL Activities relative to my physical condition and skill level, and I appreciate the types of injuries that may occur as a result of USL Activities and their potential impact on my well-being and lifestyle. I hereby assert that my participation is voluntary and that I knowingly assume all inherent risks.

Waiver of Liability for Ordinary NegligenceIn consideration of permission to participate in USL Activities and services, today and on all future dates, I, the PARTICIPANT/PARENT, on behalf of myself, my spouse, my child, my heirs, personal representatives, and assigns [hereafter referred to as  Releasing Parties] do hereby release, waive, discharge, and covenant not to sue USL, USL Teams, or league or Team owners, directors, officers, affiliates, employees, volunteers, coaches, instructors, referees, independent contractors, equipment providers, agents, and co-participants [hereafter referred to as Protected Parties] from liability from any and all claims arising from the ordinary negligence of USL/Team or the other  Protected Parties.

This agreement applies to 1) personal injury (including death) from incidents or illnesses arising from participation in USL

Activities (including, but not limited to, team tryouts, halftime activities at games, team promotional events, special events, soccer clinics, and soccer camps; this includes instruction or classes, observation, use of facilities or equipment, shower/locker room area, and all premises including the associated sidewalks and parking lots); and to 2) any and all claims resulting from the damage to, loss of, or theft of property.

Indemnification Agreement: I, the PARTICIPANT/PARENT, also agree to hold harmless, defend, and indemnify USL and Protected Parties (that is, defend and pay any judgments and costs, including investigation costs, attorney’s fees, and related expenses) from any and all claims of Releasing Parties or others acting on my behalf, arising from my participation in USL Activities (including those arising from the inherent risks of the activity or the ordinary negligence of  Protected Parties). I further agree to hold harmless, defend, and indemnify USL and  Protected Parties against any and all claims of co-participants, rescuers, and others arising from my conduct while participating in USL Activities or while I am on the premises used or controlled by USL/Team.

Clarifying Clauses: I, the PARTICIPANT/PARENT

1)    Affirm this is the entire agreement between me and USL/Team; it can be changed only by written agreement by me and an authorized member of USL.

2)    I further expressly agree that the foregoing Assumption of Risk, Waiver of Liability, and Indemnification Agreement is intended to be as broad and inclusive as is permitted by the laws of the State of Indiana and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

3)    I also understand that if any legal action is brought, the appropriate trial court for Marion County in the State of Indiana or the U.S. District Court for the Southern District of Indiana, has the sole and exclusive jurisdiction and that only the substantive laws of the State of Indiana shall apply.


Participant Agreements, Acknowledgements, and Assertions:

Health   I, the PARTICIPANT/PARENT

·       Acknowledge that USL urges participants to get medical clearance prior to participation in vigorous activities.

·       Affirm that I have no health problems that would make participation in USL Activities unwise.

·       Possess a sufficient level of skill and physical fitness for safe participation in USL Activities.

·       Acknowledge that it is my duty to inform staff and cease exercise immediately in the event of unusual discomfort (e.g., faintness, shortness of breath, high anxiety, and chest pains).

Safety    I, the PARTICIPANT/PARENT

·       Affirm that it is my duty to cease participation if I feel a hazard or playing conditions are overly perilous.

·       Will inspect the facilities and equipment and participate only if I feel they are sufficiently safe.

·       Agree to participate in activities that I feel are safe.

Injury   I, the PARTICIPANT/PARENT

·       Agree to report all injuries, both minor and more serious ones, to USL before leaving the facility.

·       Authorize USL to render emergency first aid or CPR and secure emergency medical care or transportation (i.e., EMS) when deemed necessary by USL; and I agree to assume all costs of emergency medical care and transportation.

Photo/Video/Medical Information Release   I, the PARTICIPANT/PARENT

·       Authorize the USL/Team to use photos or videos of participant in print or electronic marketing, advertising, and web content.

·       Authorize USL/Team, in emergency situation, to release my medical history information to physician/medical services.

 

COVID-19 USL Protocol

INDY ELEVEN WAIVER AND RELEASE OF LIABILITY

The undersigned hereby agrees to send my child, to The Indy Eleven camp with full knowledge of the risks associated with social interaction and COVID-19/Novel Coronavirus.  I hereby acknowledge and fully assume the risk of illness or death related to COVID-19 and hereby forever RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE (on behalf of myself and any minor children from whom I have the capacity contract) Indy Sports & Entertainment LLC (“ISE”), the United Soccer League, ISE owners, directors, officers, affiliates, employees, volunteers, coaches, referees, independent contractors, equipment providers, agents, and co-participants from any liability related to COVID-19 which might occur during the participant's time spent at The Indy Eleven Camp.

I hereby agree to withhold my child from participation in The Indy Eleven Camp if my child is not feeling well, has a cough, is running a fever, or is short of breath and will not allow my child to return to The Indy Eleven Camp until asymptomatic for 72 hours.

Acknowledgement of UnderstandingI, the Parent/Legal Guardian of the minor listed below, hereby grant my minor child permission to participate in all USL Activities. I realize that I am agreeing to let my child engage in a potentially dangerous activity. Further, I have read and fully understand the USL Assumption of Risk, Waiver of Liability, and Indemnification Agreement, and agree to be bound by this agreement on behalf of myself, my spouse, the minor child, and any party filing on behalf of the minor child. I understand that I am releasing both my right and the right of my minor child to sue for damages in the event of injury, death, or financial loss. I intend my signature to be a complete release of all liability, including that due to the INHERENT RISKS of USL Activities or the ORDINARY NEGLIGENCE of the  Protected Parties, to the greatest extent allowed by law of the State of Indiana.

Additionally, I, the Parent/Guardian of the minor child, assert that I have explained the inherent risks of USL Activities to my minor child and that the minor understands this Agreement. The following signature of the minor affirms understanding of the inherent risks of USL Activities and the voluntary assumption of these risks.


 


Name of Parent/Guardian of Minor*
Electronic Signature of Parent/Guardian*

CONCUSSIONS

Concussions affect each child and teen differently. While most children and teens with a concussion feel better within a couple of weeks, some will have symptoms for months or longer. Talk with your children’s or teens’ health care provider if their concussion symptoms do not go away or if they get worse after they return to their regular activities.

WHAT ARE SOME MORE SERIOUS DANGER SIGNS TO LOOK OUT FOR?

In rare cases, a dangerous collection of blood (hematoma) may form on the brain after a bump, blow, or jolt to the head or body and can squeeze the brain against the skull. Call 9-1-1 or take your child or teen to the emergency department right away if, after a bump, blow, or jolt to the head or body, he or she has one or more of these danger signs:

One pupil larger than the other.

Drowsiness or inability to wake up.

A headache that gets worse and does not go away.

Slurred speech, weakness, numbness, or decreased coordination.

Repeated vomiting or nausea, convulsions or seizures (shaking or twitching).

Unusual behavior, increased confusion, restlessness, or agitation.

Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously.

Children and teens who continue to play while having concussion symptoms or who return to play too soon—while the brain is still healing— have a greater chance of getting another concussion. A repeat concussion that occurs while the brain is still healing from the injury can be very serious and can affect a child or teen for a lifetime. It can even be fatal.

What Should I Do If My Child or Teen Has a Possible Concussion? As a parent, if you think your child or teen may have a concussion, you should:

Remove your child or teen from play.

Keep your child or teen out of play the day of the injury. Your child or teen should be seen by a health care provider and only return to play with permission from a health care provider who is experienced in evaluating for concussion.

Ask your child’s or teen’s health care provider for written instructions on helping your child or teen return to school. You can give the instructions to your child’s or teen’s school nurse and teacher(s) and return-to-play instructions to the coach and/or athletic trainer.

Do not try to judge the severity of the injury yourself. Only a health care provider should assess a child or teen for a possible concussion. Concussion signs and symptoms often show up soon after the injury. But you may not know how serious the concussion is at rest, and some symptoms may not show up for hours or days. The brain needs time to heal after a concussion. A child’s or teen’s return to school and sports should be a gradual process that is carefully managed and monitored by a health care provider.

To learn more, go to www.cdc.gov/HEADSUP

DISCUSS THE RISKS OF CONCUSSION AND OTHER SERIOUS BRAIN INJURY WITH YOUR CHILD OR TEEN AND HAVE EACH PERSON SIGN BELOW.
Name of Parent/Guardian of Minor*
Electronic Signature*

MEDICAL INFORMATION

EMERGENCY CONTACT INFORMATION

Emergency Contact #1*
Emergency Contact #2*
Emergency Contact #3

ADDITIONAL INFORMATION

Name of Parent(s)
Name of Parent(s)

Confirmation Page

{$143785733 ‪Number of Participants‬} {$143785734 ‪Age of Participant (Birth Year) 1st Player‬} {$143785735 ‪Age of Participant (Birth Year) 2nd Player‬} {$143785736 ‪Age of Participant (Birth Year) 3rd Player‬} {$143785737 ‪Name of Participant‬} {$143785738 ‪Name (second participant)‬} {$143785739 ‪Name (Third participant)‬} {$143785743 ‪Gender‬} {$143785744 ‪Gender (Second Participant)‬} {$143785745 ‪Gender (Third Participant)‬} {$143785747 ‪Address‬} {$143785748 ‪Home Phone‬} {$143785749 ‪Work Phone‬} {$143785750 ‪Email‬} {$143785751 ‪Shirt Size‬} {$143785752 ‪Shirt Size (Second Participant)‬} {$143785753 ‪Shirt Size (Third Participant)‬}

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