Release of Liability and Assumption of Risk Agreement

In consideration of being allowed to participate in the event or activity referenced above, I acknowledge, understand, and agree that:

Assumption of Risk – I understand that participation in this program involves significant risks of injury, including but not limited to permanent paralysis, disability, and death. While certain safety measures, including rules, equipment, and personal discipline, may reduce these risks, I acknowledge that the potential for serious injury remains.

Voluntary Acceptance of Risk – I KNOWINGLY AND VOLUNTARILY assume all risks associated with participation, whether known or unknown, including but not limited to risks arising from the NEGLIGENCE of the Releasees or others. I accept full responsibility for my participation and any resulting injury, damage, or loss.

Compliance with Program Rules – I agree to adhere to all stated and customary program rules and conditions for participation. If at any time I observe an unusual or significant hazard, I will immediately cease participation and bring it to the attention of an official.

Comprehensive Release of Liability – On behalf of myself, my heirs, assigns, personal representatives, and next of kin, I HEREBY RELEASE, WAIVE, DISCHARGE, AND HOLD HARMLESS the Releasees, including their officers, directors, agents, employees, sponsors, advertisers, affiliates, volunteers, and, if applicable, owners and lessors of the premises used for the activity (collectively, “RELEASEES”), from any and all liability related to injury, disability, death, or property damage, whether caused by the NEGLIGENCE of the RELEASEES or otherwise, to the fullest extent permitted by law.

Binding Acknowledgment – I acknowledge that:

• I have read and fully understand this Release of Liability and Assumption of Risk Agreement.
• I understand that by signing this agreement, I am waiving substantial legal rights, including my right to sue.
• I am signing this agreement freely and voluntarily, without any inducement or coercion.

US Youth Soccer - Parent/Guardian Consent And Medical Release

Recognizing the possibility of injury or illness, and in consideration for US Youth Soccer and members of US Youth Soccer accepting my son/daughter as a player in the soccer programs and activities of US Youth Soccer and its members (the "Programs"), I consent to my son/daughter participating in the Programs. Further, I hereby release, discharge, and otherwise indemnify US Youth Soccer, its member organizations and sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the Programs, against any claim by or on behalf of my player son/daughter as a result of my son's/daughter's participation in the Programs and/or being transported to or from the Programs. I hereby authorize the transportation of my son/daughter to or from the Programs.

My player son/daughter has received a physical examination by a licensed medical doctor and has been found physically capable of participating in the sport of soccer. I have provided written notice, which is submitted in conjunction with this release and attached hereto, setting forth any specific issue, condition, or ailment, in addition to what is specified above, that my child has or that may impact my child's participation in the Programs. I give my consent to have an athletic trainer and/or licensed medical doctor or dentist provide my son/daughter with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and/or treatment.

US Club Soccer Medical Treatment Authorization And Liability Waiver

I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with soccer, and hereby release, discharge, and otherwise indemnify the club, US Club Soccer, their sponsors, the USSF and its affiliated organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the soccer player named above as a result of that player's participation in US Club Soccer programs and/or being transported to or from the same, which transportation I hereby authorize.

 

Concussion Waiver

This sheet has information to help protect your children or teens from concussion or other serious brain injury. Use this information at your children's or teens' games and practices to learn how to spot a concussion and what to do if a concussion occurs.

What Is a Concussion?

A concussion is a type of traumatic brain injury or TBI caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth. This fast movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging the brain cells.

How Can I Help Keep My Children or Teens Safe?

Sports are a great way for children and teens to stay healthy and can help them do well in school. To help lower your children's or teens' chances of getting a concussion or other serious brain injury, you should:

• Help create a culture of safety for the team.
• Work with their coach to teach ways to lower the chances of getting a concussion.
• Talk with your children or teens about concussion and ask if they have concerns about reporting a concussion.
• Talk with them about their concerns; emphasize the importance of reporting concussions and taking time to recover from one.
• Ensure that they follow their coach's rules for safety and the rules of the sport.
• Tell your children or teens that you expect them to practice good sportsmanship at all times.

When appropriate for the sport or activity, teach your children or teens that they must wear a helmet to lower the chances of the most serious types of brain or head injury. However, there is no "concussion-proof" helmet. So, even with a helmet, it is important for children and teens to avoid hits to the head.

How Can I Spot a Possible Concussion?

Children and teens who show or report one or more of the signs and symptoms listed below or simply say they just "don't feel right" after a bump, blow, or jolt to the head or body may have a concussion or other serious brain injury.

Signs Observed by Parents or Coaches:

• Appears dazed or stunned.
• Forgets an instruction, is confused about an assignment or position, or is unsure of the game, score, or opponent.
• Moves clumsily.
• Answer questions slowly.
• Loses consciousness (even briefly).
• Shows mood, behavior, or personality changes.
• Can't recall events prior to or after a hit or fall.

Symptoms Reported by Children and Teens

• Headache or "pressure" in head.
• Nausea or vomiting.
• Balance problems or dizziness, or double or blurry vision.
• Bothered by light or noise.
• Feeling sluggish, hazy, foggy, or groggy.
• Confusion, or concentration or memory problems.
• Just not "feeling right," or "feeling down."

Talk with your children and teens about concussion. Tell them to report their concussion symptoms to you and their coach right away. Some children and teens think concussions aren't serious or worry that if they report a concussion they will lose their position on the team or look weak. Be sure to remind them that it's better to miss one game than the whole season.

Concussions affect each child and teen differently. While most children and teens with a concussion feel better within a couple of weeks, some will have symptoms for months or longer. Talk with your children's or teens' health care provider if their concussion symptoms do not go away or if they get worse after they return to their regular activities.

What Are Some More Serious Danger Signs to Look Out For?

In rare cases, a dangerous collection of blood (hematoma) may form on the brain after a bump, blow, or jolt to the head or body and can squeeze the brain against the skull. Call 9-1-1 or take your child or teen to the emergency department right away if, after a bump, blow, or jolt to the head or body, he or she has one or more of these danger signs:

• One pupil is larger than the other.
• Drowsiness or inability to wake up.
• A headache that gets worse and does not go away.
• Slurred speech, weakness, numbness, or decreased coordination.
• Repeated vomiting or nausea, convulsions or seizures (shaking or twitching).
• Unusual behavior, increased confusion, restlessness, or agitation.
• Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously.

Children and teens who continue to play while having concussion symptoms or who return to play too soon while the brain is still healing have a greater chance of getting another concussion. A repeat concussion that occurs while the brain is still healing from the first injury can be very serious and can affect a child or teen for a lifetime. It can even be fatal.

What Should I Do If My Child or Teen Has a Possible Concussion? As a parent, if you think your child or teen may have a concussion, you should:

• Remove your child or teen from play.
• Keep your child or teen out of play the day of the injury. Your child or teen should be seen by a health care provider and only return to play with permission from a health care provider who is experienced in evaluating for concussion.
• Ask your child's or teen's health care provider for written instructions on helping your child or teen return to school. You can give the instructions to your child's or teen's school nurse and teacher(s) and return-to-play instructions to the coach and/or athletic trainer.
• Do not try to judge the severity of the injury yourself. Only a health care provider should assess a child or teen for a possible concussion. Concussion signs and symptoms often show up soon after the injury. But you may not know how serious the concussion is at rest, and some symptoms may not show up for hours or days. The brain needs time to heal after a concussion. A child's or teen's return to school and sports should be a gradual process that is carefully managed and monitored by a health care provider.

To learn more, go to www.cdc.gov/HEADSUP

Discuss the risks of concussion and other serious brain injury with your child or teen and have each person sign below.