Recreation Baseball/Softball/T-Ball Waiver and Concussion form

COMBINED LOCKS RECREATION DEPARTMENT WAIVER FORM
PARTICIPANT WAIVER

TO BE COMPLETED BY PARENT ON BEHALF OF CHILD:
With this registration, permission is granted for participation in various activities, and I hereby, for the participants, myself, the heirs, executors, and administrators, waiver and release any and all rights and claims for damages we may have against the Village of Combined Locks, its representatives, successors, and assigns for all injuries suffered by the participants during these activities.

Permission is also granted for the Village of Combined Locks’ photographer to take photos of my child(ren) during participation in these various activities. The photos may be displayed at Memorial Ball Park, Combined Locks Civic Center, Combined Locks website and Combined Locks Face Book. I hereby release the Village’s photographer and the Village of Combined Locks from all claims and liability relating to said photographs.

The E-Sign Act and Uniform Electronic Transactions Act (UETA) in 1999 and 2000 make electronic signatures or “e-signatures” equally as valid as a handwritten signature.

PARENT & ATHLETE CONCUSSION AGREEMENT

As a Parent and as an Athlete it is important to recognize the signs, symptoms, and behaviors of concussions. By signing this form, you are stating that you understand the importance of recognizing and responding to the signs, symptoms, and behaviors of a concussion or head injury.

I have read the Parent Concussion and Head Injury Information and understand what a concussion is and how it may be caused. I also understand the common signs, symptoms, and behaviors. I agree that my child must be removed from practice/play if a concussion is suspected.

I understand that it is my responsibility to seek medical treatment if suspected concussion is reported to me.
I understand that my child cannot return to practice/play until providing written clearance from an appropriate health care provider to his/her coach.
I understand the possible consequences of my child returning to practice/play too soon.

 

The E-Sign Act and Uniform Electronic Transactions Act (UETA) in 1999 and 2000 make electronic signatures or “e-signatures” equally as valid as a handwritten signature.