Name *

First Name

Last Name

Birth Date *

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DD

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Phone

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Emergency Contact *

First Name

Last Name

Emergency Contact Phone # *

(###)

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Waiver *

I acknowledge that soccer or any sporting event is an extreme test of a person’s physical and mental limits and carries with it the potential for death, serious injury, or property loss. I recognize that I may be asked to practice for, participate in, and travel to and from soccer events on behalf of the team and I HEREBY ASSUME ALL RISK OF INVOLVED PARTICIPATION IN ALL THE IMAGO DEI EAGLES PROGRAMS. I agree that prior to participating, I will inspect the facilities and equipment to be used and if I believe anything is unsafe, I will immediately advise the coach or supervisor of such condition(s) and refuse to participate. I hereby take the following action for myself, my executors, administrators, heirs, next of kin, successors and assigns: . a) I WAIVE, RELEASE, AND DISCHARGE from any and all claims, actions, causes of actions, suits and/ or liabilities for death or personal injury or damages of any kind, which arise out of or relate to my participation in, or my traveling to and from the Imago Dei Eagles programs, THE FOLLOWING PERSONS OR ENTITIES: the Imago Dei Eagles; the . Imago Dei Eagles, Missionary Athletes International (MAI), the players for which I am training with; the players for which I am playing against; any sponsors obtained by theImago Dei Eagles; any Players or Coaches; any Officers, Directors, Employees, Representatives and Agents of the above. 
 . b) I AGREE NOT TO SUE nor bring any type of lawsuit against any persons or entities mentioned above for any of the claims or liabilities that I have waived, released or discharged herein; and 
 . c) I INDEMNIFY AND HOLD HARMLESS the persons or entities mentioned above from any claims made or liabilities assessed against them as a result of my actions or a result in my participation in the event. 
 I am aware that photos and videos taken of myself and/or my child(ren) during Imago Dei Eagles events may be used in future advertising or marketing and we consent hereto. I hereby affirm that I have read the attached Volunteer Form, understand and agree with the Imago Dei Eagles mission and core values. I will commit to regular weekly attendance in my assigned neighborhood for an entire school year. In the case of absence, I will communicate directly with the program leader. I hereby affirm that I am eighteen (18) years of age or older and I have read this document and I understand its contents. I understand that I have given up substantial rights and MAI accepts no responsibility for any damage to the person or loss to personal belongings by signing this document voluntarily.

Yes