DSSC ID Clinic

Dunedin Stirling Soccer Club is pleased to offer 5 free soccer clinics at our home field. This is an opportunity for our local players who are interested in joining Dunedin to come see the club.

DSSC FREE ID CLiNIC

* Indicates required field

Name *

First

Last

Gender *

Date of Birth *

Playing Position *

Date of Attendance *

April 3rd 9:00 - 10:30AM April 10th 9:00 - 10:30 AM April 11th 10:30 - 12:00 PM May 1st 9:00 - 10:30 AM

Parent Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Dunedin Parks & Recreation Department Release, Waiver and Indemnification
I, _____________________________________, for myself, my heirs and personal representatives, and for the minor child, _____________________________________, and his/her heirs and personal representatives, hereby assume for myself and said child, all liabilities, risks of loss, property damage, injuries, including death, and hazard incidental to participation in all activities and programs offered by the City of Dunedin Parks and Recreation Department or other sponsoring organization in which I, or said child, participate(s), including transportation to or from the activity or program. I represent that I am the natural parent or legal guardian of said child and have full lawful authority to execute this release, waiver and indemnification on behalf of said child, binding myself and said child and the child’s heirs and personal representatives to the undertakings herein set forth. I am aware of, and acknowledge, the fact that this activity or program may involve physical contact or other inherent risks where injuries may occur. I do hereby waive, release and agree indemnify and hold harmless the CITY OF DUNEDIN, its officers, agents, employees, the organizers, sponsors, activity supervisors, and co-sponsoring organizations for and from any claim, demand, liability, costs, suits, charges or compensation for loss, damage, injury of any kind, or death, including losses or injuries arising from the negligence of the CITY OF DUNEDIN, its officers, agents, employees, sponsors, organizers, or activity supervisors, that may occur as a result of my, or said child’s participation in, or presence at, the activity or program. I assume all risk of injury, liability, and loss arising from the child’s participation in or presence at said activity. I acknowledge that the CITY OF DUNEDIN will not assume any costs relating to any injury while the child is involved in this activity.
This waiver, release and indemnification is in consideration of the CITY OF DUNEDIN or activity sponsor permitting my, or said child’s, participation in the activity or program and in further consideration of the CITY OF DUNEDIN not requiring self-funded liability insurance coverage as a condition precedent to my, or said child’s, participation in the activity or program. I freely and voluntarily assume for myself and for the said child all risk of loss or injury arising from the child’s participation in the activity whether due to the child’s negligence, or the negligence of others. I acknowledge that, absent this release and indemnification, the CITY OF DUNEDIN or other sponsor of the activity or program would not have offered me, or said child, access to the activity or program because of unacceptable exposure to liability claims.
I have read this Release, Waive and Indemnification form in its entirety and understand the terms and conditions it contains and sign it freely and voluntarily, and understanding that I waive legal rights to which I and the child might otherwise be entitled if the child is hurt or suffers loss during the child’s participation in the activity. I represent and warrant that I have full legal authority to execute this form for the purposes expressed herein as natural parent or legal guardian of the minor child.
This Release, Waiver and Indemnification for shall remain in full force and effect for all activities or programs until such time as the undersigned withdraws this Release, Waiver and Indemnification form in writing and delivers same to the City of Dunedin Parks and Recreation Department.
• YOU MUST CAREFULLY READ THIS DOCUMENT BEFORE SIGNING IT.
• YOU ARE WAIVING OR RELEASING VALUABLE LEGAL RIGHTS.
• YOU ARE ADVISED TO SEEK THE ADVICE OF AN ATTORNEY IF YOU DO NOT FULLY UNDERSTAND
THIS DOCUMENT.

Sign Here *

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