Waiver/Release of Liability Agreement

Players Name  ________________________________________________________

East End Field Hockey does not provide medical insurance for players in the event of illness or injury requiring
medical treatment. I hereby accept any and all responsibility for, and assume the risk of and all injury and damages
to the above named player, which might arise directly or indirectly as a result of and or participation in Field
Hockey. East End Field Hockey and its employees, coaches, and officers can not be held responsible for any and all
injuries that may occur. If medical attention is required in any East End Field Hockey activity, we (I) give permission
for such medical care to be administered.

We (I) hereby consent to the use of above named players image by East End Field Hockey for any and all
purposes including without limitation, video, still photographs, publications, any trade or advertising purpose.

I also under stand that there are no refunds or credits for any reason.

I certify that we (I) am familiar with the contents of this release, that we (I) have read and understand the same,
and that it is our(my) intention by signing this release that the same is binding not only to me, but my heirs,
administrators, executors, successors and assigns.

Players Signature  ____________________________________________Date ___________________

Parent/Guardian Signature  ____________________________________________________________

Insurance Carrier

Policy Number