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LA Premier Covid-19 Waiver


We, the undersigned parent(s) or legal guardian(s) of the undersigned minor “Player” for ourselves and on behalf of the Player, our heirs, assigns, and agents acknowledge that participation and/or receiving instruction in water polo necessarily involves travel, play in adverse weather conditions, physical contact and risk of severe and permanent physical injury.  For myself, and on behalf of the Player, our heirs, assigns, and agents, we willingly and voluntarily accept and assume all such risk.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my or my child(ren)’s attendance and/or participation in Premier activities.  On my behalf, and on behalf of my child(ren), I hereby release, covenant not to sue, discharge, and hold harmless Premier, its directors, officers, employees, volunteers, agents, and representatives, of and from all claims, including all liabilities, actions, damages, costs or expenses of any kind arising out of or relating thereto.  I understand and agree that this release includes any claims based on the actions, omissions or negligence of LA Premier Water Polo Club (hereinafter “Premier”), its directors, officers, employees, volunteers, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Premier program. 

Description of Activity of Program includes practices, competitions, or gatherings of any and all kinds involving water polo, including but not limited to conditioning, cross-training, education, clinics, any other activities located at association facilities, on dryland, beach sand activities, and in  open water (e.g. bays, oceans, lakes, etc.).

We understand and agree that this Release will have the effect of releasing, discharging, waiving and forever relinquishing any and all actions or causes of action that we may have or have had, whether past, or future, whether known or unknown, and whether anticipated or unanticipated by me, arising out of my participation and/or receipt of instruction in water polo.  This Release constitutes a complete release, discharge and waiver of any and all actions or causes of action against Premier.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I, or other members of my family, may be exposed to, or infected by COVID-19 as a result of attending Premier activities, and such exposure or infection with COVID-19, may result in personal injury, illness, permanent disability, and death.  I understand that the risk of becoming exposed to, or infected by COVID-19 at a Premier activity may result from actions, omissions, or negligence from myself and others, including but not limited to, Premier, its directors, officers, employees, volunteers, agents, and other program participants and their families.

Severability:   I further agree that this Release Agreement for COVID-19 is intended to be as broad and inclusive as permitted by law, and that if any portion is held invalid, the remaining portions will continue to have full legal force and effect.

Governing Law and Jurisdiction:   This Agreement shall be governed by the laws of the State of California, and any disputes arising out of or in connection with this Agreement shall be under the exclusive jurisdiction of the Courts of the State of California. 


EMERGENCY MEDICAL AUTHORIZATION:   (Agent: Authorized Agent of Premier)

I/We, parent(s)/person(s) having legal custody/legal guardian of a minor, do hereby authorize medical, dental or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or on the medical staff of any hospital, whether such diagnosis or  treatment is rendered at the office of said physician, dentist or at said hospital.  It is understood that this authorization is given in advance of any special diagnosis, treatment, or hospital care being required but is given to provide authority to the aforesaid Agent to give specific consent to any; and all such diagnosis, treatment, or hospital care which a physician or dentist meeting the requirements of this authorization may in the exercise of his/her best judgment deem advisable. 

This authorization is given pursuant to the provisions of Sections 6910 and 6550 of the Family Code of California.

This authorization applies to all Premier activities conducted independent of any school or other organization and shall remain effective until December 31, 2021, unless sooner revoked in writing delivered to said agent(s).

ACKNOWLEDGMENT AND CONSENT:   We acknowledge that we have read this Release Agreement and that we understand the terms, and understand that we and the Player have given up substantial rights by our signing this Release Agreement and agreeing to these terms, and we sign this Release Agreement and agree to these terms freely and voluntarily and without inducement for ourselves and on behalf of the Player.

Parent Signature: ____________________________________

Athlete Name: ______________________________________

Date: ______________________________________________