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Mon Valley Dek Hockey Physical Injury Waiver & Hold Harmless Agreement

Registrant's Name ____________________________ Date of Birth ____________ Age________
Address ________________________Phone (day)________________(night)________________
City/State/Zip ___________________________________Emergency Number:_______________
Name of Team ______________________________Division ____________________________

I, the applicant, ________________________________, am hereby requesting to participate in the physical contact sport known as "Dek Hockey" at the Mon Valley Dek Hockey. I understand that Dek Hockey is a physical contact sport and acknowledge that I am assuming any and all risks, hazards, and injuries including, but not limited to, death incidental to participation in such a physical contact sport, either as a participant and/or spectator, as well as any such injuries and/or damages including, but not limited to death sustained in the course of transportation to an from Dek Hockey activities. I am fully aware of the fact that physical collisions between or among players in this sport are common and that physical injuries including, but not limited to, death can result. I accept any and all hazards of participation in said sport and the dangers of injury including, but not limited to, death incident thereto, including, but not limited to, injuries or damages arising from the negligence or carelessness of fellow players, referees, staff, spectators, and present on or near property on which the facility is located. I assume said risk whether my involvement is as a participant or spectator.

I am also aware that Dek Hockey is played out of doors under various weather conditions, which may cause the surfaces to become slippery when wet or moist. The surface on which the sport is played may come apart under certain conditions and injury may result, in such event, as well as by virtue of collisions with the surface, the retaining wall, net and net structures and other structures on or near the playing area. I ACCEPT ALL OF THE HAZARDS AND RISKS OF PARTICIPATION IN THIS PHYSICAL CONTACT SPORT AND HEREBY WAIVE, RELEASE, ABSOLVE, INDEMNIFY, AND AGREE TO HOLD HARMLESS, the organizers, sponsors, supervisors, participants, owners of the business and owners of the premises as well as any and all providers of equipment or services to the facility, as well as persons, whether in the course of the organized play or while I am at a Dek Hockey facility, or being transported to or from a facility, by or on the part of any person or entity present at or near the facility, including but not limited to, and all damages or injuries including, but not limited to, death arising as described above.

I further understand and agree that in the event that litigation is instituted against any of the above protected parties, I shall indemnify and hold such party harmless from any and all costs of defending said claim including, but not limited to, all reasonable attorney fees and/or costs involved therein.
I further understand and agree that it is my responsibility to learn, understand, and obey the rules governing play, including any special written rulles of the Mon Valley Dek Hockey and any special rules communicated to the team captain/representative by the management of the Mon Valley Dek Hockey. I further understanf and agree that players violation any such rules are subject to suspension in the sole discretion of management of the Mon Vally Dek Hockey with no money refunded to me.

I HEREBY ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND THIS DOCUMENT. I FURTHER UNDERSTAND AND AGREE THAT IT CONSTITUTES A WAIVER OF CERTAIN LEGAL RIGHTS WHICH I MAY HAVE. MY SIGNATURE HEREON HAS IN NO WAY BEEN COERCED AND I SIGN IT VOLUNTARILY AND OF MY OWN FREE WILL.

Applicants Signature__________________________________________________ Date_____________________

I am the present legal guardian of the above named minor applicant. I hereby give my approval and consent to my childs participation in the physical contact sport of Dek Hockey and in any and all league activities at the Dek Hockey sports facility. I have completely read this Physical Injury Waiver and Hold Harmless Agreement and fully understand the risks involved to attendant thereto. I further hereby agree, on behalf of my child, to be bound by the provisions of this Physical Injury and Hold Harmless Agreement.

Parents Signature_____________________________________________________ Date_____________________
Address (Street, City, State, Zip) __________________________________________________________________