ATHLETE’S RELEASE OF ALL CLAIMS

I, ____________________________, the undersigned person, hereby request permission to participate in the USA Hockey InLine program, with Las Cruces Inline Hockey Association, under a Special Waiver and Release. I certify to you that I am physically and mentally able to participate in the above named program, with its emphasis the sport of inline hockey. Further, I wish to participate in this inline program and its related events and activities and knowingly assume the risk of play involving players older than myself. In consideration of being allowed to participate under a Special Waiver and Release, I understand and agree to the following:

1. I understand that the activities involved in this USA Hockey InLine program may be dangerous, and that the risk of injury from the activities is significant, including the potential for permanent paralysis and death. Further, I understand and accept that, while particular rules, protective equipment, and personal discipline may reduce this risk, the risk of serious injury does exist. I also understand and accept that the risk of injury is inherent with participation in any inline hockey program, and that any such injury may be caused by contact(s) with items such as, but not limited to, other players, sticks, pucks, skates, protective glass/netting, goal nets, the dasher boards, coaches or managers, and / or the playing surface itself; and

2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees shown below or others, and assume full responsibility for my participation; and

3. I hereby agree to abide by, and comply with, the conditions and rules for participation in this program, as may be amended from time to time. If, however, I notice anything unsafe, I agree to immediately stop participating and to notify the nearest coach, instructor, manager or official; and

4. I hereby release the ____________________________ league, its program, the officers, directors, officials, volunteers, agents an/or employees, its coaches and instructors, other participants, sponsoring agencies and USA Hockey, Inc., any team or league sponsors or advertisers, and if applicable, the owners and lessors of the premises used to conduct this program and related program events (“the Releasees”), with respect to this agreement, and any or all injury, disability, death, loss or damage to person(s) or property(s) incidental to my involvement or participation in this program or its related activities, whether arising from the negligence of the releasees or otherwise.

5. I hereby indemnify and hold harmless, all of the above Releasees, from and against any and all claims and liabilities incident to my involvement or participation in this USA Hockey InLine program or any of its related activities, even if arising from the negligence of any of the releasees shown above or otherwise.

I have read this Release of Liability, its Assumption of Risk Provisions and Indemnity Agreement, and I fully understand and agree to all of the terms, conditions and limitations contained in the document. Further, I understand and accept that I will have given up substantial legal rights by signing this document. I hereby sign this document freely and voluntarily without any inducement or promises having been made in return for any signature.

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Printed Name of Participant Date Signed by Participant

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Signature of Participant

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Signature of Parent or Guardian Date Signed by Parent or Guardian

USAH InLine (4/00)