Player's Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Parent's Name *

First Name

Last Name

Emergency Contact *

First Name

Last Name

Emergency Contact Phone # *

(###)

###

####

Waiver *

I, the undersigned, on behalf of myself and/or my child(ren), acknowledge that participation in activities associated with MAI/Imago Dei is voluntary. I understand and accept that athletic and physical activities inherently involve risk of injury. I hereby release and forever discharge MAI/Imago Dei, its officers, agents, employees, volunteers, and members—both officially and individually—of and from any and all claims, demands, rights, or causes of action of any kind, known or unknown, arising from injury, damage to property, or death resulting from participation in any activity connected to or sponsored by MAI/Imago Dei. I voluntarily assume all such risks. I further agree not to sue or bring any form of legal claim against MAI/Imago Dei or its representatives for any matters covered under this waiver. I agree to indemnify and hold harmless MAI/Imago Dei and its affiliates from any claims brought as a result of my or my child(ren)’s actions, or participation in MAI/Imago Dei activities. In the event that I or my child(ren) sustain injury or illness during participation in any MAI/Imago Dei activity, I hereby authorize emergency first aid, medication, medical treatment, or surgery deemed necessary by qualified medical personnel. I further authorize attending medical personnel to execute on my behalf any required medical documentation or decisions if I am not immediately available. I affirm that I and/or my child(ren) have no physical disabilities, impairments, or medical conditions that would inhibit participation, and that I am unaware of any reason participation should be medically restricted. I assume full responsibility for any resulting medical expenses. I give permission for my child(ren) to travel to and from MAI/Imago Dei activities in vehicles operated by authorized staff or volunteers. I acknowledge and accept the risks associated with such transportation, including personal injury or property damage.

Yes

Promotion Waiver *

Lastly, I grant permission for MAI/Imago Dei to use photographs, audio recordings, and video footage of myself and/or my child(ren) in promotional materials, including but not limited to publications, websites, social media platforms, and advertising. I waive any right to inspect or approve the finished product or its use.

Yes

No