COMMUNICABLE DISEASE
RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
5/18/20
Participant’s Name__________________________________________________ Birthdate_________________________
Street Address ____________________________________City ______________________________ Zip____________
Parent/Guardian’s Name_______________________________________________ Emergency Phone (_____)______________
Parent/Guardian’s Name_______________________________________________ Emergency Phone (_____)______________
In consideration of being allowed to participate in any way in the program, related events and activities, I the
undersigned, acknowledge, appreciate, and agree that:
I am aware there are risks to me of exposure to directly or indirectly arising out of, contributed to, by, or resulting from
an outbreak of any and all communicable disease, including but not limited to, the virus “severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2)”, which is responsible for Coronavirus Disease (COVID-19) and/or any
mutation or variation thereof.
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE,
INDEMNIFY, AND HOLD HARMLESS THE ILLINOIS YOUTH SOCCER ASSOCIATION, its MEMBER LEAGUES
AND CLUBS, its directors, officers, officials, agents and/or employees, associated personnel, other participants,
sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES),
from any and all claims, demands, losses, and liability arising out of or related to any ILLNESS, INJURY, DISABILITY
OR DEATH I may suffer, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE,
to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND
ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT
FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
X_____________________________________________________________ __________ ________________
Signature of Participant aged 18 or older Age Date
FOR PARENTS/GUARDIANS OF PARTICIPANT UNDER AGE 18 (MINOR) AT TIME OF REGISTRATION
This is to certify that I, as parent/guardian with legal responsibility for this Participant, do consent and agree to his/her
release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree
to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or
participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE
RELEASEES, to the fullest extent permitted by law.
X_______________________________________________________________ _________________________
Signature of Parent/Guardian for Participant under age 18 Date
X_______________________________________________________________ _________________________
Signature of Parent/Guardian for Participant under age 18 Date
