FLAG FOOTBALL REGISTRATION & DETAILS

I, the parent or guardian of the child above grant permission for him/her to participate in the Pee Wee Football program of the Weatherford Optimist Club. I, the parent or guardian legally authorize to do so, hereby authorize coaches or league officials permission to secure emergency medical service in case of injury, and hereby authorize the above named, to be treated by any qualified, licensed physician who is available to do so in the event the need for treatment arises and our family physician can’t be reached.

In any matter arising from the organized sports program including, but not limited to, any negligent act of omission of the Weatherford Optimist Club and it’s agents, servants, volunteers, officers, and employees, the undersigned hereby assumes all the risks and hazards incidental to the child’s participation, and agrees to release, indemnify, and hold harmless Weatherford Optimist Club, Optimist International, and their agents, servants, volunteers, officers, and employees from all liability, costs, expenses, claims, and damages sustained as a result of accident, damages, or injury to the person or property, or both, of the above named.

I signify by my signature below that I understand that the Weatherford Optimist Club provides only supplemental medical insurance and that any hospital or medical bills in relation to Pee Wee Football will be the responsibility of the parent or guardian’s insurance first. The insurance provided by the Weatherford Optimist Club has a deductible of $100 to be paid by the injured player’s parent/guardian. I also understand that it is my responsibility to file all claims concerning insurance payments.

This authorization is valid at all times, including whenever I am not immediately available to give my consent to such treatment.