Midwest Soccer Academy
Waiver, Release, Hold Harmless, and Indemnification Agreement

As consideration for being allowed to enter the play area and/or participate in any party and/or    program at Midwest Soccer Academy the undersigned, on his or her behalf, and on the behalf of the Participant(s) identified below, acknowledges, appreciates, understands, and agrees to the following:
1. I represent that I am the parent or the legal guardian of the Participant(s) named below to execute this agreement on their behalf.

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Participant NameDOBParticipant Name DOB

2. I acknowledge and understand that there are risks associated with participation in Midwest Soccer Acadamy activities and the use of the play are and inflatable equipment including but not limited to: contusions, fractures, scrapes, cuts, bumps, paralysis, or death.

3. I, for myself, the Participant(s) named, willingly assume the risks associated with participation and accept that there are also risks that may arise due to Other Participants which I also willingly assume.

4. I agree that the Participant(s) named, and I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for participation in any party and or program at Midwest Soccer Academy.

5. I, for myself, the Participant(s) named, our heirs, assigns, representatives, and the next of kin agree to hold harmless and indeminfy the owner of Midwest Soccer Academy, Hawthorne Site Management Co., their predecessors, parent, subsidiaries and affiliates, officers, and employees from any and all injuries, liabilities or damages from participation.

6. I additionally agree to indeminify the owner of Midwest Soccer Academy, Hawthorne Site management Co., their predecessors, parent, subsidiaries and affiliates, officers and employees for any defense cost or expense arising from any and all claims, injuries, liabilities or damages arising from participation.

7. I am of physical ability to participate and am legally competent to understand and complete this agreement.  I hereby execute this agreement without coercion.

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Participant Parent/Guardian:  Print NameDate

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Participant Parent/Guardian: Signature    Date

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Address (Street,City,State& ZipCode)

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Emergency Contact Name and Phone NumberEmail Address