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waiver .pdf


Original filename: waiver.pdf
Author: UHS

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WAIVER AND RELEASE OF LIABILITY
In consideration of being allowed to participate in the programs and/or events of the
Indiana Youth Track Association (“IYTA”) as well as the Fishers Fire, Body in Training,
Northside Saints, Carmel Track Project and Westfield Track Associations (“member Associations”),
including but not limited to track and field events and cross country events, the person executing
this registration form represents, acknowledges and agrees that:
1. I am the parent, custodian and/or legal guardian of the minor(s) identified on this
registration form.
2. The risk of injury from involvement in IYTA activities are significant and include the
potential for death and/or permanent injury, which risks are reduced, but not eliminated
by the observance of rules, use of protective equipment and personal discipline.
3. I, on my own behalf and for the minor child identified on this form (and on behalf of
each of our heirs, assigns, and next of kin), knowingly and freely assume
all such risks, both known and unknown, and hereby release, discharge and agree to hold
harmless IYTA and its member associations, and their respective directors, officers,
employees, officials, referees, umpires, coaches, trainers, agents, participants, sponsors,
sponsoring agencies, advertisers, and, if applicable, owners and/or lessors of the
premises used to conduct the IYTA activities (collectively the “releasees”) from and
against any liability, loss, cost or expense with regard to any injury to the fullest
extent permitted by law. Disability or death, or any other loss or damage to persons or
property, even if arising from the negligence of any of the releasees, or others and
hereby assumes full responsibility for participation.
4. I understand that it is my responsibility to report any evidence of any form of sexual
misconduct to IYTA and/or member associations.
5. I understand that my service, in any capacity, in connection with any of the IYTA
activities, requires that I observe applicable laws and community standards to avoid
allegations of any type of misconduct or wrongdoing.
6. I hereby acknowledge and grant IYTA, its member associations and each of their
respective officers, directors, employees, agents and contractors, the right
to photograph me and/or my child and use still photographs, video images and any other
reproductions of our physical likenesses in, and in connection with, exhibitions,
advertisements, websites, on television or otherwise, in connection with promotion,
advertising, and/or publicizing IYTA and it's member associations. However, this waiver
does not grant the right to use my name or my child’s name in connection with our
photograph, video or any other reproduction of our likeness. I hereby waive any and all
rights to compensation in connection with the utilization of any such photographic or
video media.

7. I understand that some of the IYTA and its member associations are affiliated with
state organizations and that the information provided on this form may be given to those
organizations if my child is participating in one of those sports.
________________________________________
Signature of Parent or Guardian

________________________________________
Print name of Parent or Guardian

________________________________________
Name of minor and Club

Date:___________________


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