Lehigh Valley Health Network (“LVHN”)
Participant Waiver and Release
The Parent/Legal Guardian named above (referred to as "I" or "me") desires for my child (the participant named above) to participate in the program described above (the “Program”). In consideration of my child having the opportunity to participate in the Program, I agree to all the terms and conditions set forth in this Participant Waiver and Release (“Release”).
Informed Consent and Acknowledgement of Risk. I hereby give my approval for my child’s participation in any and all activities associated with the Program. There is a risk of being injured that is inherent in all sports activities. This risk includes the risk of minor injuries as well as severe injuries. I am aware that these risks exist in connection with my child’s participation in the Program, and I voluntarily elect to have my child participate in the Program, knowing that such participation involves these risks.
Waiver and Release. On behalf of myself and my child, I WAIVE, RELEASE, AND DISCHARGE LVHN and its affiliates, LVHN personnel, Program sponsors, facility providers, participants, coaches, and volunteers, and their respective parent, subsidiary, affiliated and/or related entities, trustees, directors, officers, employees, agents, or representatives (“Released Parties”) from any and all liability relating to or arising from my child’s participation in the Program (including their traveling to and from the Program), including but not limited to, liability arising from personal injury or disability, property damage, property theft, or other actions of any kind.
Fit to Participate. I certify that my child is medically and physically able and sufficiently prepared to participate in the Program. If I experience any doubt as to my child’s ability to successfully and safely participate in and/or complete the Program, I certify that I will stop my child’s participation in the Program and take full responsibility for consulting a physician. I certify that, if my child is disabled in any way or has recently suffered an illness, injury, or impairment, I consulted a physician prior to their participating in the Program. I certify that there are no health-related reasons or problems that preclude my child’s participation in the Program.
Compliance with Program Rules. On behalf of myself and my child, I agree that we will: (i) comply with all rules and safety procedures that accompany the Program; (ii) exhibit appropriate behavior at all times; and (iii) obey all applicable laws and instructions from LVHN personnel. LVHN personnel may remove me and/or my child from the premises, in their sole discretion, if our behavior is inconsistent with these terms.
Medical Treatment Consent. In the event of injury to my child or if my child is need of medical attention, I consent to LVHN personnel, Program sponsors, facility providers, participants, coaches, and/or volunteers providing: medical care to my child directly or through personnel of their choice; transportation for medical care by other providers; and/or emergency medical services. I agree that none of the foregoing persons have a duty to provide any medical care and/or services. I further agree to be financially responsible for the cost of all such medical care and services.
Media and Photography Authorization. Upon clicking "Submit", you will be redirected to complete LVHN's Authorization and Release for Media Participation and Use and Disclosure of Information.