LIABILITY RELEASE - TALENT RELEASE – TRAVEL AUTHORIZATION

MEDICAL TREATMENT AUTHORIZATION FOR A MINOR

1. My child (child’s first and last name)____________________________, is a child less than 18 years old and is hereafter referred to as "my child.” My child has my permission to participate in soccer tryouts, camps, practices, scrimmages, games, indoor soccer, parties, field trips, and other activities, including travel to and from, hereafter known as “functions”, which may be scheduled from time to time by the San Andreas Youth Soccer Organization (SAYSO).

2. On behalf of members of my family, I authorize SAYSO to arrange transportation in buses, trains, and planes and other vehicles and equipment to these functions. My child and family members have my permission to ride in transportation arranged by SAYSO, regardless of whether or not vehicles and equipment are owned and/or operated by commercial transport companies, public utilities, SAYSO, parents, coaches, or other individuals.

3. My child is in good health and is able to participate in these functions.

4. My child will use protective equipment (e.g., soccer boots, shin guards, eye protection, head protection, teeth protection, padded goalkeeper equipment, etc.) or, if my child doesn’t, my child does so at his/her own risk and with my permission. My child may use his/her head to return or redirect soccer balls that come to my child.

5. While my child is participating in these functions, I HEREBY AUTHORIZE THE ADULT COACHING STAFF, or in their absence, any accompanying or assisting adult, TO ADMINISTER ANY EMERGENCY FIRST AID OR MEDICAL ATTENTION “ON THE SPOT,” AND TO CONSENT TO TREATMENTS FOR MY CHILD, including but not limited to, any x-ray examination, anesthetic, medical, or surgical diagnosis or treatment, and hospital care which is advised by, and is to be rendered under the general or special supervision of, any physician, surgeon, or dentist, AND, I AGREE TO PAY FOR SAME. I consider SAYSO's soccer academy program to be a school, and this authorization is given pursuant to the provisions of Sections 6550-6552 of the California Family Code. This authorization shall remain effective indefinitely, until my child no longer plays with SAYSO. A PHOTOCOPY OF THIS SIGNED AUTHORIZATION IS AS VALID AS THE ORIGINAL.

6. I authorize any hospital or provider of medical attention to surrender physical custody of my child to SAYSO upon completion of treatment. This authorization is given pursuant to Section 1283 of the Health and Safety Code of California.

7. I understand that tryouts and some other functions may not be covered by any insurance, and that I AM SOLELY RESPONSIBLE for the cost of any service or treatment provided. After registering with SAYSO, I will be responsible for the cost of any treatment provided which is not covered by insurance.

8. I understand that soccer is a strenuous physical sport, can be dangerous, and there is an inherent risk of injury. I HEREBY RELEASE AND HOLD HARMLESS SAYSO, the team’s regular, guest, and volunteer coaching staff, parental helpers and assistants, team members and their families, referees and other game officials, and the city and school district of the function location from any suits, claims, charges, demands, losses, damages, and expenses incurred from any and all illnesses and injuries incurred, regardless of cause or severity, that may befall my child during functions. I understand that it is not possible to recognize or correct every dangerous condition or physical field hazard or to anticipate every injurious event, and I RELEASE AND HOLD HARMLESS the individuals and organizations listed in this paragraph from those responsibilities. These releases and these authorizations remain valid indefinitely, can only be changed or revoked in writing, and then, only when signed by SAYSO.

9. Any photographs or videos taken of my child by SAYSO may be used for promotional and commercial purposes in printed, audiovisual, or electronic form, including on SAYSO's website and brochures.

10. The information I have provided to SAYSO is true, accurate, and complete. No verbal promises of any nature contradicting this agreement and release have been made, can be made, or ever will be made to me. Legal fees and other costs shall be awarded to the prevailing party in arbitrated or legal disputes.

11. I am the parent or legal guardian of my child and am authorized to sign this agreement. I will keep SAYSO informed about any changes in the status of parent/legal guardianship for my child.

Printed Name __________________________Signature:__________________________(mother) Date:_____________

Printed Name __________________________Signature:__________________________(father) Date:_____________
SAYSO Tryout Liability Release rev. May 2005