Waiver Form

City of Phoenix and the Phoenix Scorpions Inc.

ASSUMPTION OF RISK AND PERSONAL RESPONSIBILITY

Phoenix Scorpions Cactus Classic Field Hockey Tournament – January 30-21, 2010

PRINT NAME__________________________________________________________

As consideration for access to services and facilities of Desert West Sports Complex, and participation in the Phoenix Cactus Classic Field Hockey Tournament, I agree as follows:

I acknowledge that this activity is not without risk and the safeguards taken cannot constitute a guarantee that injury will not occur.  The elements that contribute to the unique character of this activity can be causes of injury, illness, or in extreme cases, permanent trauma or death.  The Phoenix City and the Phoenix Scorpions do not want to reduce my enthusiasm for this activity, but finds it necessary to educate me in advance of what to expect and inform me of the inherent risks in participating in the tournament.

I understand the description of these risks is not complete and that other unknown or unanticipated risks may result in property loss, injury, or death.  I agree to assume responsibility for the risks identified herein and those risks not specially identified including the acts of other participants or third parties.  My participation in this tournament is purely voluntary, no one is forcing me to participate, and I elect to participate with the full knowledge of the risks.

I have verified with my physician or other medical professionals that I have no past or current physical or psychological condition that might affect my participation in this tournament.  I authorize the Phoenix Scorpions to provide emergency hospitalization or other medical care for me and that I will be responsible for such care and related costs.

I certify that I have the requisite skills and fitness level to participate in this tournament, without causing harm to myself or others.  Also, both my participation in this tournament and my decision to sign this document are purely voluntary.  Therefore, I, and my parent(s) or guardian if I am a minor, assume full responsibility for me and for bodily injury, death, and loss of personal property and expenses suffered by me and them as a result of those risks and dangers identified herein and those risks and dangers not specifically identified, and as a result of my negligence, and as a result of acts of other participants or of third parties.  I also agree to be responsible for damages of injuries caused by me, whether to persons or to property including, but not limited to, City of Phoenix/Phoenix Scorpions property.

I, and my parent(s) or guardian if I am a minor, have read and understand and accept the terms and conditions states herein.  I agree to release and hold harmless the Phoenix City, the Phoenix Scorpions, its officers, members and any volunteers from any injuries, damages or claims arising from or related to causes described or referred to in this document, and I acknowledge that this agreement shall be effective and binding upon myself, my heirs, assigns, personal representative and estate and all members of my family.

Signed_____________________________________  Date______________________

(Participant)

I am signing as a parent or guardian and agree to hold harmless and waive my right of recovery from Phoenix City, the State of Arizona, and their officers, agents, employees, volunteers and The Phoenix Scorpions for any claim that may be brought by or on behalf of the participant, or any member of the participant’s family, for injury or loss resulting from those inherent risks of the activity, described and not described above, and from the negligence of the participant.

Signed_____________________________________  Date______________________

(Parent or Guardian if participant is under 18)