Media, Liability, and Medical Release to be completed by parent/guardian
PERMISSION FOR PARTICIPATION IN THE CHEVRON SOCCER ACADEMY, RELEASE OF LIABILITY: I, the undersigned, certify that I am the parent or legal guardian of the above-mentioned Participant. I hereby authorize my minor child named above to attend and participate in The Chevron Soccer Academy, which includes the Chevron STEM Zone and all activities provided by For Soccer Ventures (collectively, “Activities”). I understand that my minor child must obey all established rules and follow the instructions of the person in charge of these activities. I consent to and understand that the person in charge of the Activities or agents have the right to dismiss my child who is in their opinion a hazard to the safety and well-being of others. Prior to the participation of my minor child, I acknowledge that there are certain risks associated with certain Activities, including, by way of example, physical injury due to activity-related incidents, physical injury due to transportation-related incidents, illness, or even death. I acknowledge that there may be other risks inherent in these Activities of which I may not be presently aware. Accordingly, I acknowledge that participation in such Activities involves certain dangers and risks which may expose my child to hazards of bodily injury or property damage, and which may result in my child being unable to contact me or being unable to receive immediate medical care and assistance if injury occurs.
ASSUMPTION OF RISK AND RELEASE OF LIABILITY: By signing this parental consent and release of liability form (checking the box below) (“Release”), I expressly warrant that my child named above is capable of withstanding both the physical and mental demands associated with any Activities for which he or she is registered. I also expressly assume all risks to my child’s participation in the Activities, whether such risks are known or unknown to me at this time, including, but not limited to personal injury, disease, death, property loss, or other damages which may result from my child’s participation in the Activities made available by For Soccer Ventures, Chevron STEM Zone, or in any other associated programs or activities. In recognition of these risks and realities, and in consideration of my child being offered the opportunity to participate in and benefit from the Activities, I, on behalf of myself and my child, hereby release, waive, and disclaim any and all liabilities of or claims, including those which arise out of negligence, against For Soccer Ventures, Chevron U.S.A. Inc., EARTHQUAKES SOCCER, LLC, and QUAKES FOUNDATION, Salinas Regional Soccer Complex, the State of California, Soccer United Marketing, LLC, Major League Soccer, L.L.C., and each of their respective parents, subsidiaries, affiliates, officers, board members, agents, faculty, employees, volunteers, successors, assignees, licensees, and all private persons or organizations providing services to transport, supervise, or chaperone my child while participating in the Activities (the “Released Parties”) including, but not limited to any or all liabilities or claims for personal injury, property damage, court costs, attorneys’ fees and interest, however, caused or accrued, as a result of my child participating in The Chevron Soccer Academy.
WAIVER AND RELEASE/COVID-19 WAIVER AND RELEASE. I shall not bring any claim, demand, legal action or suit against the Released Parties for any economic or non-economic loss arising out of or in any way connected to exposure to COVID-19 during or in connection with my participation in the Activities, or because of the operations and conduct of the Released Parties or others, whether negligent or otherwise. I understand that an inherent danger and risk of exposure to novel coronavirus SARS-CoV-2 and any resulting disease (together with any mutation, adaptation or variation thereof, “COVID-19”) exists in any public place where people are present. I understand that COVID-19 is an extremely contagious disease that can lead to severe illness and death, that no precautions can eliminate the risk of exposure to COVID-19, and that the risk of exposure applies to everyone. I understand that, according to the Centers for Disease Control and Prevention (CDC), senior citizens (people 65 and older) and people with underlying medical conditions are especially vulnerable, including people with chronic lung disease or moderate to severe asthma, serious heart conditions, compromised immune systems, severe obesity, diabetes, chronic kidney disease undergoing dialysis, and liver disease. I also understand that contracting COVID-19 can result in the further transmission of COVID-19 to my spouse, family members and other contacts. By participating in the Activities, I knowingly and voluntarily assume and accept personal responsibility for all risks in any way related to exposure to COVID-19, including illness, injury, or death, and including without limitation, all risks based on the sole, joint, active or passive negligence of any of the Released Parties.
MEDIA RELEASE: I hereby give For Soccer Ventures, Chevron U.S.A. Inc., SAN JOSE EARTHQUAKES, the State of California, Soccer United Marketing, LLC, Major League Soccer, L.L.C., designated advertising agencies, promotional agencies, networks or platforms, and all entities involved in the development, execution, distribution or promotion of the Activities or any related materials and their respective parents, subsidiaries, and affiliates, and their legal representatives assigns, and licensees (collectively, the “Licensees”) the right and permission to photograph, digitally record, videotape, or audio tape, my above-named child while he/she is participating in the Activities. I further agree that the Licensees may use any or all of the material recorded worldwide, in any form, in all media now known or hereinafter invented, in social media, in publications, including electronic publications, or in audio-visual presentations, promotional literature, advertising, (including political advertising) or in other similar ways, and that such use shall be without payment of fees, royalties, special credit, or other compensation, or any right of approval by me or my child. I understand that all such recordings, in whatever medium, shall remain the property of the entity that made or commissioned them. I further represent, covenant and warrant that my child is not a member of any collective bargaining organization, including, but not limited to, the Screen Actors Guild and the American Federation of Television and Radio Artists. I hereby forever release, indemnify and hold harmless the Licensees arising out of or in connection with the exercise of the rights related to the recorded materials by the Released Parties, including any defamation (including libel and slander), invasion of privacy, right of publicity, copyright infringement, or any other personal or property rights from or related to any use of the recorded materials.
MEDICAL AUTHORIZATION / CONSENT FOR MEDICAL TREATMENT OF A MINOR: I recognize that there may be occasions where the minor child named above, may be in need of first aid or emergency medical or dental treatment as a result of an accident, illness, or other health condition or injury. Therefore, I authorize any Chevron Soccer Academy staff or adult volunteer, in whose care the minor child has been entrusted, to consent to any X-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment, and hospital care, to be rendered to the minor as permitted by the laws of the jurisdiction in which such treatment is required by the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. As parent or legal guardian of my minor child (Participant named above), I am responsible for the health care decisions of my minor child and am authorized to consent to the services to be rendered. I represent that my consent to, and agreement to pay for, dental, medical, and/or hospital care or treatment to be rendered to my minor child is legally sufficient and that no consent from any other person is required. By checking the box below, I authorize any Chevron Soccer Academy staff or adult volunteer, in whose care the minor child has been entrusted to authorize any hospital or physician or other health care provider to bill the appropriate insurance company or companies for the payment of any services rendered to the minor child. I agree to assume responsibility for the charges for such care as rendered to the above-named minor child. I authorize any hospital, physician, or other health care provider to release information from the minor child's medical record to the appropriate insurance company, in connection with the completion of any insurance claim form.
I intend this Release to be a full waiver and release of all claims of any nature my child had, now has, or may in the future have against the Released Parties, and each of their advertisers, assignees, successors, officers, directors, agents, representatives, licensees, employees, sub-contractors, sponsors, shareholders, partners, members and affiliates in connection with his/her participation in the Activities. I acknowledge that I may (on behalf of my child) have or may in the future have claims against the Released Parties which I presently do not know or suspect to exist in my favor at the time I execute this Release which if known, might materially affect my execution of this Release. I expressly waive all right I may have under Section 1542 of the California Civil Code, which states:
“A general release does not extend to claims THAT THE CREDITOR OR RELEASING PARTY DOES not know Or suspect to exist in HIS OR HER favor at the time of executing the release AND THAT, if known by him OR HER, WOULD have materially affected his OR HER settlement with the debtor OR RELEASED PARTY.”
Health and Safety Protocols: I acknowledge that I will be subject to certain policies, procedures and protocols that will be implemented from time to time by the Chevron Soccer Academy and/or third parties (including, but not limited to, federal and state governmental agencies) (collectively, the “Health and Safety Protocols”) in order to mitigate potential exposure to and spread of COVID-19 and agree to comply with such Health and Safety Protocols. I further acknowledge that the Health and Safety Protocols may prove inadequate to mitigate potential exposure and transmission of COVID-19 and that it is possible that from time-to-time persons present at the Activities may not comply fully with the Health and Safety Protocols. Accordingly, the implementation of the Health and Safety Protocols does not guarantee that I will not be exposed to or contract COVID-19 as a result of my entering or remaining present at the Activities and may not mitigate the risk of contracting COVID-19 or transmitting COVID-19 to others.
CHOICE OF LAW: This Release shall be construed in accordance with the laws of the California without respect for its choice of law provisions. By checking the box below, I acknowledge that I have read, understood and agreed to the information above. All releases, authorizations and permission granted above shall remain in effect unless revoked in writing by the undersigned to For Soccer Ventures or Chevron U.S.A. Inc.