Grissom Tiger’s “Kicking-In The Year”

Indoor Soccer Tournament

Release of All Claims and Statement of Responsibility

For and in consideration of our child’s ___________________________________ (printed first & last name) participation in the Grissom Tiger “Kicking-In The Year” Indoor Soccer Tournament, January 13-15, 2006. We hereby release, acquit, forever discharge, indemnify, and hold harmless, Grissom High School Women’s Soccer Boosters, Grissom High School, Huntsville City Schools, YMCA of Metropolitan Huntsville, all tournament sponsors, and their respective officers, employees, agents, referees, and representatives of and from any and all claims, demands, actions, or causes of action, liability, or damage arising out of or in any way related to participation of our child in the Grissom Tiger “Kicking-In The Year” Indoor Soccer Tournament and related activities.

We further certify that our child has our permission to participate in the Grissom Tiger “Kicking-In The Year” Indoor Soccer Tournament and related activities. In the even of injury or illness to our child, we hereby grant authority to a qualified physician to render such medical treatment as said physician deems reasonable and necessary, and we also accept responsibility for any expense involved with such illness, injury, and treatment.

Signature of

Parent/Guardian: Date:

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Child’s Name:

Address:

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Emergency Contact & Phone Number: PH #

Insurance Company:

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