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Coach Sefa requires that you complete this Release of Liability, Authorization to Treat, and Media Release form prior to the first day of camp/clinic. All parents and guardians must sign these waivers or the minor will not be allowed to participate.

Participant Info

Assumption of Risk, Release of Liability and Indemnification

I understand RISKS are involved in playing soccer such as (but not limited to) being struck by a soccer ball or other body. I expressly agree to ASSUME and ACCEPT these risks. As a parent or guardian, I expressly permit the participant listed above to take part in this sport and related activities throughout the duration of the Sports Camps.

I voluntarily agree to RELEASE and DISCHARGE Coach Sefa LLC,

its owners, officers, managers, members, employees, agents, and affiliates from any and all liability, cause of action, lawsuits, claims, demands, damages, judgments, costs, expenses or loss including responsible attorney fees arising out of or relating the Summer Camp Programs or related activities.

I also agree to INDEMNIFY and REIMBURSE Coach Sefa LLC, its owners, officers, managers, members, employees, agents, and affiliates for any and all liability causes of action, lawsuits, claims, demands, damages, judgments, costs, expenses or loss including reasonable attorney fees

arising out of or relating to the Summer Camp Programs or related activities.

Coach Sefa is not responsible for lost or forgotten balls, clothes or other personal items left at the end of camp day. Children are responsible for their own personal property.

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Location

North Chesterfield, 23236

Phone

571-330-2285

Email

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