Parent /Guardian Consent Form
PLEASE READ THE FOLLOWING CAREFULLY AND COMPLETE THE REQUIRED INFORMATION, THANK YOU.
MUST BE COMPLETED BY EVERYONE UNDER THE AGE OF 18, AND SIGNED BY PARENT OR GUARDIAN.
INFORMED ACKNOWLEDGEMENT & CONSENT.
I hereby give my approval for my child’s participation in any and all activities prepared by The Keeper Academy during training. In exchange for the acceptance of said child’s candidacy by The Keeper Academy. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Keeper Academy and all its respective officers, agents, and representatives from any and all liability for injuries to the said child arising out of traveling to, participating in, or returning from training sessions.
In case of injury to said child, I hereby waive all claims against The Keeper Academy including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including soccer. Some of these injuries include but are not limited to the risk of fractures, paralysis, or death. By completing the registration process, you understand and agree to all terms within the Informed Consent and Acknowledgement section.
MEDICAL RELEASE AUTHORIZATION:
As Parent and/or Guardian of the named goalkeeper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.
Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.
Permission is also granted to The Keeper Academy and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.
Release authorized on the dates and/or duration of the registered event.
This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence. By completing the registration process, you understand and agree to all terms within the Medical Release and Authorization section.
By signing this release form, I authorize The Keeper Academy LLC to use the following personal information:
(1) My child's picture – including photographic, motion picture, and electronic (video) images.
(2) M child's voice – including sound and video recordings.
BY ACKNOWLEDGING AND SIGNING/ SUBMITTING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL.