PARENT/GUARDIAN’S RELEASE OF ALL CLAIMS

I, ____________________________, the undersigned parent and/or guardian of (hereinafter called “the Athlete”) ________________________________, do hereby request permission for the named Athlete to participate in the Las Cruces Inline Hockey Association USA Hockey InLine program. I represent and warrant to you that the Athlete is physically and mentally able to participate in the above named USA Hockey InLine Program, with its emphasis the sport of inline hockey. Further, I wish for the Athlete to participate in this InLine Hockey Program and its related events and activities and knowingly assume the risk of the athlete playing inline hockey with players older than said athlete. In consideration of being allowed to participate, I understand and agree to the following:

1. I understand that the activities involved in this USA Hockey InLine Program are 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 to the Athlete 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 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 the Athlete’s participation; and

3. I hereby agree to abide by, and comply with, the conditions and rules for participation in this USA Hockey InLine Program, as may be amended from time to time, and will instruct the Athlete to comply with the stated and customary terms and conditions for participation. If I observe any unusual significant concern in the Athlete’s readiness for participation and/or in the program itself, I will remove the Athlete from participation, and will immediately bring such to the attention of the nearest coach, instructor, manager or official; and

4. I hereby release the ____________________________ USA Hockey InLine Program, its officers, directors, officials, volunteers, agents and/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 InLine Hockey 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 the Athlete’s involvement or participation in this Adult Hockey Program or its related activities, whether arising from the negligence of the releasees or otherwise.

5. I, for myself and on behalf of the Athlete, heirs, assignees, personal representatives and next-of-kin, do hereby indemnify and hold harmless, all of the above Releasees, from and against any and all claims and liabilities incident to the Athlete’s 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 the terms, conditions and limitations contained in the document. Further, I understand and accept that I have given up substantial rights by signing this document. I hereby sign this document freely and voluntarily without any inducement or any promises having been made to me in return for my signature.

__________________________________________ _____________________________

Printed Name of Parent / Guardian Date Signed by Parent / Guardian

__________________________________________

Signature of Parent / Guardian

USAH InLine (4/00)