2007 Old Mill Invitational Waiver

(Please Staple Waiver to Birth Certificate for each player)

CHILD’S NAME _________________________________________________________

ADDRESS ______________________________________________________________

PARENT’S OR GUARDIAN’S NAME _______________________________________

PHONE __________________________

I hereby agree that the Old Mill Soccer Association (OMSA) and the Peotone Park District (PPD), its’ officers, members, or coaches shall not be held liable for any injury or loss which my child may sustain while participating in activities of any kind whether sponsored by or under the supervision of OMSA or PPD. I agree to indemnify and hold harmless OMSA and PPD, its’ officers, members, coaches or designates of any kind from any claim whatsoever.

PARENT OR GUARDIAN SIGNATURE _____________________________________

DATE ____________________________