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Indy Eleven Soccer Camp

 

HOSTED BY ZYSA (JAN. 2-4)

Age Group*
What age group is the participant in?
Age Group (Second Participant)*
What age group is the participant in?
Age Group (Third Participant)*
What age group is the participant in?
Name of Participant*
Name (second participant)*
Name (Third participant)*
Gender*
Gender (Second Participant)*
Gender (Third Participant)*
What club team do you play for?
Address*
How did you hear about this event?*

MEDICAL INFORMATION

WAIVER AND RELEASE FORM

ASSUMPTION OF RISK, WAIVER, RELEASE, INDEMNIFICATION, AND MEDIA AUTHORIZATION (INDY ELEVEN COMBINES/TRYOUTS)

In consideration of being allowed to participate in soccer combines/tryouts the undersigned hereby agrees as follows:

1. Acknowledgement and Assumption of Risk. The undersigned hereby expressly acknowledges that physical activity, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries, that participation by the undersigned in the Event operated by Indy Eleven will require extensive physical activity, and that some of such physical activity will involve strenuous exertions of strength using various muscle groups, some will involve quick movements including speed and change of direction, and others will involve sustained physical activity that places stress on the cardiovascular system. The specific risks vary, but risks range from (a) minor injuries such as scratches, bruises, and sprains, to (b) major injuries such as loss of sight, joint or back injuries, concussions, and heart attacks, to (c) catastrophic injuries including paralysis and death.

I HEREBY CONFIRM THAT MY PARTICIPATION IN THE EVENT IS VOLUNTARY, AND I UNDERSTAND THAT MY PARTICIPATION IN THE EVENT MAY INVOLVE RISK OF SERIOUS INJURY OR DEATH, INCLUDING ECONOMIC LOSSES, WHICH MAY RESULT NOT ONLY FROM MY OWN ACTIONS OR INACTION (INCLUDING NEGLIGENCE), BUT ALSO FROM THE ACTIONS OR INACTION (INCLUDING NEGLIGENCE) OF OTHERS, THE CONDITION OF THE FACILITIES, EQUIPMENT, OR AREAS WHERE ACTIVITIES ARE BEING CONDUCTED, OR THESE TYPES OF ACTIVITIES IN GENERAL. FURTHER, I KNOWINGLY ASSUME ALL RISKS AND DANGER (KNOWN AND UNKNOWN) OF PERSONAL INJURY TO, AND OF ANY DAMAGE TO OR LOSS OF ANY PROPERTY OF, THE UNDERSIGNED ARISING OUT OF OR IN ANY WAY RELATING TO THE UNDERSIGNED'S PRESENCE AT THE EVENT, WHETHER OCCURRING PRIOR TO, DURING OR SUBSEQUENT TO THE UNDERSIGNED’S PARTICIPATION IN OR OBSERVANCE OF THE EVENT OR OTHER ACTIVITIES. I REPRESENT AND WARRANT THAT I AM IN GOOD HEALTH AND HAVE NO PHYSICAL CONDITION THAT WOULD PREVENT, OR PRESENT AN UNDUE HEALTH RISK FROM, PARTICIPATION IN THE EVENT OR OTHER ACTIVITIES.

I agree that prior to my participation in the Event or other activities, I will inspect the facilities, equipment and area where the same are being conducted and, if at any time I believe any of them are unsafe, I will immediately advise the person supervising the activities and discontinue participation in such activities. I willingly agree to comply fully with all expressly stated and customary terms and conditions for participation in the Event or other activities.

2. WAIVER, RELEASE, AND INDEMNIFICATION. THE UNDERSIGNED HEREBY EXPRESSLY, UNCONDITIONALLY, AND IRREVOCABLY AGREES THAT, TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, INDY ELEVEN, ITS AFFILIATES, AND THEIR RESPECTIVE EMPLOYEES, AGENTS, OFFICERS, MEMBERS, MANAGERS, SHAREHOLDERS, DIRECTORS, CONTRACTORS (INCLUDING LESSORS OR LICENSORS OF ALL OR ANY PORTION OF THE FACILITIES, EQUIPMENT OR OTHER PROPERTY USED FOR THE EVENT), AND OTHER REPRESENTATIVES (COLLECTIVELY, THE "RELEASED PARTIES"), AND EACH OF THEM, SHALL HAVE NO LIABILITY FOR ANY SUCH INJURIES, LOSSES OR DAMAGES. WITHOUT IN ANY WAY LIMITING THE FOREGOING, TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, THE UNDERSIGNED HEREBY EXPRESSLY, UNCONDITIONALLY AND IRREVOCABLY WAIVES AND RELEASES ANY CLAIM OR CAUSE OF ACTION THE UNDERSIGNED MAY HAVE AGAINST ANY OF THE RELEASED PARTIES ARISING OUT OF ANY SUCH INJURIES, LOSSES OR DAMAGES, EVEN IF ARISING OUT OF THE NEGLIGENCE OF SUCH RELEASED PARTY. THE UNDERSIGNED ALSO AGREES, TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, TO INDEMNIFY, DEFEND AND HOLD HARMLESS EACH OF THE RELEASED PARTIES FROM AND AGAINST ANY AND ALL CLAIMS, CAUSES OF ACTION, LOSSES, LIABILITIES, DAMAGES, JUDGMENTS, COSTS OR EXPENSES (INCLUDING REASONABLE ATTORNEY’S FEES) WHICH RELATE TO SUCH INJURIES, LOSSES OR DAMAGES OR TO INJURIES, LOSSES OR DAMAGES THE UNDERSIGNED CAUSES TO OTHERS PRESENT PRIOR TO, DURING, OR AFTER THE EVENT.

3. Media/Photo Authorization. I hereby grant to Indy Eleven the unrestricted right to use, adapt, reproduce, display and publicly air, in any medium throughout the world in perpetuity, my name, visual likeness, voice, and biographical data, in whole or in part, in connection with the advertising, promotional or marketing activities of Indy Eleven or its affiliates, without notice, review, approval, or compensation to me. Without limiting the foregoing, I hereby authorize and give my full consent to Indy Eleven and its affiliates to copyright and/or publish any and all photographs, videotapes and/or film in which I appear while attending the Event. I further agree that Indy Eleven and its affiliates may transfer, use or cause to be used, these photographs, video tapes, or films for any exhibitions, public displays, publications, commercials, art and advertising purposes, and television, radio or internet programming without limitations or reservations.

4. Interpretation; Severability; Choice of Law & Forum. The language in all parts of this instrument shall be in all cases construed simply according to its fair meaning and not strictly against either the undersigned or any Released Party. Wherever possible, each provision of this instrument shall be interpreted in such a manner as to be valid under applicable law, but, if any provision of this instrument shall be invalid or prohibited there under, such invalidity or prohibition shall be construed as if the legally impermissible portion of such invalid or prohibited provision had not been inserted herein and shall not affect the remainder of such provision or the remaining provisions of this instrument. I agree that this instrument will be governed by the internal laws of the State of Indiana, and that if legal action is brought, it must be brought in Marion County, Indiana.

I have read this Assumption of Risk, Waiver, Release, Indemnification, and Media Authorization, and I fully understand its terms. I understand that by signing below I am giving up substantial rights (including the right to sue), and that I am undertaking substantial obligations (including the obligation to indemnify Indy Eleven). I acknowledge that I am signing it freely and voluntarily. I declare that I am over the age of 18 years, and that I am otherwise fully competent to sign this instrument on my own behalf.

Electronic Signature*

ADDITIONAL INFORMATION

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

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PAYMENT OPTIONS

Indy Eleven Soccer Camp hosted by ZYSA Image
Indy Eleven Soccer Camp hosted by ZYSA*
Indy Eleven is proud to begin a partnership with ZYSA by providing a 3 day soccer camp. This camp will allow young players to have access to our brand new curriculum, professional level players, and enter for a chance to win an autographed jersey from the 2018 campaign!
$ 100.00
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