I hereby voluntarily permit me or my child to participate in the activities of the Burning River Soccer Club (BRSC). I UNDERSTAND AND FULLY ACCEPT THAT THERE ARE RISKS INVOLVED IN SPORTS, AND THAT ACCIDENTS AND INJURIES ARE COMMON AND ARE ORDINARY OCCURRENCES OF SPORTS. I HEREBY AGREE TO ACCEPT ANY AND ALL RISKS OF INJURY OR DEATH. As consideration for being permitted by BRSC to participate in these activities, I hereby release and hold harmless Burning River Soccer Club, staff, volunteers, designated coaches, and program officials from all liability, and from all actions or claims that I or my child now or hereafter have for damage or injury to me or my child, or to any person or property, resulting from the negligence or other acts of any employees or volunteers in connection with me or my child’s participation. I further agree that this waiver, release and assumption of risks is to be binding on the heirs and assigns of the undersigned. I further agree to indemnify and to hold BRSC (its officers, employees, agents and volunteers) free and harmless from any loss, liability, damage, cost or expense which they may incur as a result of any injury and/or property damage that I or my child may cause or sustain while participating in this activity. In case of a medical emergency, I hereby give permission to BRSC Staff, Trainers and Volunteers to order treatment for me or my child, including any necessary medical treatment and x-rays. I also hereby give permission to BRSC Staff and Volunteers to disclose the information contained on this form to medical personnel. I understand that an attempt will be made to reach me by phone when a diagnosis is completed. I agree to pay all medical, hospital, or other expenses which my child or I may incur as a result of such treatment. BRSC also does not provide any medical or other insurance protection or benefits for those who participate in tournaments and leagues. I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND THE BURNING RIVER SOCCER CLUB AND ACCEPT THE TERMS OF MY OWN FREE WILL. PARENT/GUARDIAN CLICK HERE TO AGREE (Required) *
Name *
Youth Player Name
Date of Birth *
Date of Birth
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Address *
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Mobile Phone *
Mobile Phone
Secondary Phone *
Secondary Phone
Has your family participated on a team sport in an organized and competitive format?