NOTE: Since this is the start of a new season, ALL PLAYERS must fill-out the waiver, even if they are LAC Returnees or have attended a clinic over the summer
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PLEASE READ CAREFULLY - THIS AGREEMENT AFFECTS IMPORTANT LEGAL RIGHTS
In consideration of being permitted to participate in any way, including travel to and from related events and activities of the Lanikai Athletic Club (LAC), I, for myself, my personal representatives, heirs, executors, next of kin, and assigns, do hereby:
I have read the above waiver, indemnification, and release of liability agreement, and understand that I give up substantial rights by signing it and knowing this, sign it voluntarily. I further agree that no oral representations, statements, or inducements, apart from the above agreement have been made. I agree that this agreement is intended to be as broad and inclusive as is permitted by law and if any portion is held invalid, it is agreed that the balance shall, notwithstanding, continue to have full force and effect. I agree to participate knowing the risks and conditions involved and do so entirely upon my own free will. I also acknowledge that if English is not my first language, that I have sought out the assistance of someone competent to translate this form to me. My signature below shall be a declaration that I have so read and understand this Waiver, Indemnification, and Release of Liability Agreement. A photocopy of this Waiver will have the same effect as the original.
I/we the undersigned parent, parents or legal guardian of the above named minor, do hereby authorize in the event of an injury, accident, or illness, Lanikai Athletic Club (LAC), its coaches, team representatives, directors, officers, agents, and assignees to seek and obtain care and medical treatment as shall be necessary under the circumstances.
I/we hereby authorize and direct the above named to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment and hospital care which is deemed advisable and rendered under the general or special supervision of any member of the medical staff and emergency room staff licensed under the provisions of the Medical Practice Act, of a dentist licensed under the provisions of the Dental Practice Act, and on the staff of any general hospital holding a current license to operate a hospital from the State Department of Public Health or its equivalent. This authorization is effective whether such diagnosis or treatment is rendered at the office of said physician or dentist, at a hospital, or elsewhere.
It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of my aforementioned agents to give specific consent to any and all such diagnosis which in the exercise of his or her best judgment may deem advisable. It is understood that effort shall be made to contact the undersigned before rendering treatment to the patient, but that any of the above treatment will not be withheld if the undersigned cannot be reached. I also agree that this authorization to treat shall be valid in any state where such treatment is rendered. I also agree that if English is not my first language that I have sought out someone to translate this form to me and agree that by my signature that I have read and understood the document.
A photocopy of this Authorization will have the effect as the original.
By participating voluntarily, and on my own accord in the Lanikai Athletic Club (LAC), I hereby grant Lanikai Athletic Club (LAC), its agents and licensees, and other authorized media including television, radio, and newspapers, unrestricted permission to:
This permission shall apply to all activities in which I participate as part of Lanikai Athletic Club (LAC) including its extended or subsequent related activities.
I/we understand that the above information will be distributed to members of the public and media to: publicize the activities of Lanikai Athletic Club (LAC) as well as the performance of individual participants; promote Lanikai Athletic Club (LAC) as an organization in the sports community; and communicate information to participants and their families the success of Lanikai Athletic Club (LAC).
I/we understand that the participants name and likeness may be included on the Lanikai Athletic Club (LAC) website and that performances may be webcast over the Internet to interested persons Lanikai Athletic Club (LAC) members of the public at large, and may be videotaped and/or digitally captured for later webcast, broadcast and/or transmission. This grant includes without limitation perpetual rights for both internal use and for licensing, sale, or other transfer of the videotapes or digital files to third parties, and includes transmission and display over the Internet. This permission is irrevocable and royalty free and I understand that Lanikai Athletic Club (LAC) will act in reliance on this permission.
I/we are the parent/legal guardian of the participant and minor listed on Page One and have the authority to make this agreement on behalf of the participant.