MARCUS ICE HOCKEY ASSOCIATION
&
FLOWER MOUND HIGH SCHOOL HOCKEY CLUB
SUMMER 2015
WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
1. In consideration for participating in Marcus Ice Hockey Association (MIHA) and/or Flower Mound High School Hockey
Club (FMHSHC) club events and member team activities, the sport of ice hockey, and/or activities incidental thereto
(including, but not limited to practices, games, off-ice conditioning and other off- or on-ice team events), I, the undersigned
Participant (and the parent or legal guardian of Participant, if applicable), hereby WAIVE, RELEASE, DISCHARGE, AND
COVENANT NOT TO SUE MIHA or FMHC, its directors, officers, agents, coaches, employees and volunteers (together
and hereinafter RELEASEES) for any and all liability, claims, demands, and cause(s) of action for any loss, damage or
injury, including for personal injury, property damage or death that may be sustained by me or to any property belonging to
me, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise, arising out of my participation in such
activities whenever or however they may occur, or while in, on or upon the premises where such activities are being
conducted or in transportation to and from said premises.
2. To the best of my knowledge, I can fully participate in these activities. I (and Participant’s parent or guardian, if
applicable) fully understand there are risks and hazards connected to the activities and to the sport of ice hockey, including
but not limited to the risks noted herein. I hereby elect to voluntarily participate in said activities, and to enter in to the
premises where such activities may occur and engage in such activities knowing that the activities may be hazardous to me
and my property. These risks and hazards include, but are not limited to, those arising from participating with bigger, faster
and stronger participants. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY
DAMAGE OR PERSONAL INJURY, INCLUDING BODILY INJURY, PARTIAL OR TOTAL DISABILITY, PARALYSIS OR
DEATH, that may be sustained by me, or any loss or damage to property owned by me, which may arise from my
participation in said activities, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise.
3. I (and Participant’s parent or guardian, if applicable) AGREE TO DEFEND, INDEMNIFY AND HOLD HARMLESS THE
RELEASEES from any and all loss, liability, damage, or costs, including court costs and attorney’s fees, that may incur due
to my participation in said activities, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES or otherwise.
4. I (and Participant’s parent or guardian, if applicable) agree to become familiar with and to abide by and be bound by the
rules of the MIHA, FMHSHC and USA Hockey as currently published. I further agree not to violate said rules, or any directive
or instruction made by the person or persons in charge of said activities and that I will further assume the complete risk of
any activity done in violation of any rule, directive or instruction.
5. I UNDERSTAND THAT MIHA AND FMHC WILL NOT BE RESPONSIBLE FOR ANY MEDICAL COSTS ASSOCIATED
WITH AN INJURY I MAY SUSTAIN.
6. I also understand that I should and am urged by MIHA and FMHSHC to obtain adequate health and accident insurance
to cover any personal injury to myself which may be sustained during said activities or transportation to and from said
activities.
7. It is my express intent that this Agreement shall bind the members of my family, if I am alive, and my heirs, assigns,
and personal representative, if I am not alive, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND
COVENANT NOT TO SUE the above named RELEASEES.
8. I further agree that this Agreement shall be construed in accordance with the laws of the State of Texas.
POSSIBLE INJURIES WHICH MAY OCCUR
There are risks involved when participating in the sporting activities by MIHA and FMHC and its member teams. Some
of the possible injuries and bodily harm which can occur through participation in said activities are listed below. This list is
provided to make the prospective Participant aware of the possibilities of injuries which may be sustained. The individual is
completely responsible for his own safety and health.
POSSIBLE INJURIES: strains, sprains, pulls, tears, cramps, infection, rashes, vomiting, bruises, contusions, wounds
(abrasions, incisions, lacerations, punctures, avulsions), insect bites, dislocation, blisters, nosebleeds, broken bones,
fractures, choking, respiratory or heart failure, heat exhaustion, heat stroke, fainting, nerve damage, shock, paralysis,
concussion, and in an extreme case, death.
BODY AREAS WHICH MAY BE AFFECTED OR INVOLVED IN SPORTS INJURIES: head, face, eye, ear, jaw, teeth,
mouth, neck, nose, chest, abdominal, back, arms, elbow, hands, fingers, wrist, shoulders, genital organs, scalp, bones, leg,
knee, hip, ankle, feet, toes, internal organs, nerves, muscles, ligaments, cartilage, joints, tendons, spinal cord, arteries and
veins, brain.
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I/my child have reviewed the above information and am aware of the risks in participating in a sports program and the
possible injuries which may occur. I/my child freely and voluntarily agree to participate in any and/or all of the said activities
which are offered by MIHA, FMHC and their member teams.
IN SIGNING THIS AGREEMENT, I (and Participant’s parent or guardian, if applicable) ACKNOWLEDGE AND
REPRESENT THAT I have read the above paragraphs and have not relied upon any representations, statements or
inducements apart from the foregoing written Agreement. I execute this Agreement for full, adequate and complete
consideration fully intending to be bound by same.
__________________________________
Participant’s Name (Print)
__________________________________ Age _______ Date Signed _______________________
Participant’s Signature
__________________________________
Parent/Guardian Name (Print)
__________________________________ Date Signed _______________________
Parent/Guardian Signature (if Participant is under 18 years of age)
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