Medical Release

In considerations of North Metro Soccer Association and allowing my child to participate in the North Metro Soccer Association club programming, I agree not to sue and forever release, waive and discharge NMSA and their respective employees, governors, affiliates, agents, partners, owners, members, parents, subsidiaries, representatives, officers, attorneys and players (hereinafter referred to collectively as “Releasees” from any and all liability to me, my child and his or her personal representatives, assigns, heirs, children, dependents, spouse and relatives for any and all claims, causes of action, losses, judgments, liens, costs, demands or damages that are caused by or arise from any injury (including death) to his/her person or property regardless of the cause(s) of such injury. I assume all risks associated with my child’s participation in and observation of North Metro Soccer Association.

I certify that my child is in good mental and physical condition. My child and I understand the inherent risks associated with participation in the sport, and we also understand the inherent risks of participating in the sport of soccer at this level on grass, astro-turf and athletic court surfaces. I recognize the possibility of physical injury associated with soccer, and in consideration of above organizations discharge and otherwise indemnify the organizations, the affiliates and sponsors, their employees and associated personnel (whether paid or volunteer) as well as the owners of the fields and facilities utilized for the programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the programs.

I, the parent/legal guardian of the registrant, authorize North Metro Soccer Association staff to seek medical treatment for the Participant as they deem necessary at local medical facilities. I understand that this authorization is given in advance of any specific diagnosis, treatment or hospital care, and that it is given to provide the NMSA staff authority to seek medical treatment as he/she judge’s necessary to the above-named Participant. I accept responsibility for payment of all services rendered; I authorize any medical facility that renders services to release medical information necessary for the processing of insurance claims; and I authorize the payment of insurance claims directly to the medical facility. I understand that whenever possible, NMSA will make a good faith effort to contact me or the above named person(s) before seeking treatment. If this is not possible, I understand that NMSA staff will notify me, or my designee, as soon as possible of any and all diagnoses and treatments. I also hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.

Sponsors & Affiliates

Minnesota Youth Soccer Association

MN United FC

US Youth Soccer

Challenger Sports Camp

Coerver

Andover Community Center

The Sanneh Foundation

Dick's Sporting Goods