Medical Treatment Authorization

The Player, I hereby give consent for emergency medical care prescribed by a duty licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve my life, limb(s), or well-being.

Beach Chalet Soccer Club Insurance Release Form

1. The Risk Of Injury From The Activities Involved In This Program Is Significant, Including The Potential For Permanent Paralysis And Death, And While Particular Skills, Equipment, And Personal Discipline May Reduce This Risk, The Risk Of Serious Injury Does Exist; And, 2. I Knowingly And Freely Assume All Such Risks, Both Known And Unknown, Even If Arising From The Negligence Of The Releasees Or Others, And Assume Full Responsibility For My Participation; And, 3. I Willingly Agree To Comply With The Stated And Customary Terms And Conditions For Participation. If However, I Observe Any Unusual Significant Hazard During My Presence Or Participation, I Will Remove Myself From Participation And Bring Such To The Attention Of The Beach Chalet Soccer Club, And Ricardo Costenaro(GM) Immediately; And, 4. I, For Myself And On Behalf Of My Heirs, Assigns, Personal Representatives And Next Of Kin, Hereby Release, Indemnify, And Hold Harmless The Beach Chalet Soccer Club LLC, San Francisco Parks E Recreation Agency, And The City And County Of San Francisco, Their Officers, Officials, Agents And/or Employees, Other Participants, Sponsoring Agencies, Sponsors, Advertisers, And, If Applicable, Owners And Lessees Of Premises Used For The Activity ("Releasees"), With Respect To Any And All Injury, Disability, Death, Or Loss Or Damage To Person Or Property, Whether Arising From The Negligence Of The Releasees Or Otherwise, To The Fullest Extent Permitted By Law. 5. This Is To Certify That I, As Individual Or Parent/guardian With Legal Responsibility For This Participant, Do Consent And Agree To His/her Release As Provided Above Of All The Releasees, And, For Myself, My Heirs, Assigns, And Next Of Kin, I Release And Agree To Indemnify And Hold Harmless The Releasees From Any And All Liabilities Incident To Myself And/or My Minor Child's Involvement Or Participation In These Programs As Provided Above, Even If Arising From The Negligence Of The Releasees To The Fullest Extent Permitted By Law. 6. I Further Acknowledge That For Both The Internal And External Use, Beach Chalet Soccer Club And Ricardo Costenaro May Compile Address, Phone Numbers, And Mailing Labels And May Utilize Soccer Photographs And Video Footage Of The Named Individual. I Consent To Such Uses And Hereby Waive All Rights Pertaining Hereto Including All Rights To Compensation.

​

I Have Read This Release Of Liability Form And Assumption Of Risk Agreement, Fully Understand Its Terms, Understand That I Have Given Up Substantial Rights By Signing It, And Sign It Freely And Voluntarily Without Any Inducement.