4th Connecticut Middle School Track and Field Championship Meet
Rockville High School
Participant Waiver & Release Form
· I voluntarily agree to participate in the 4th Connecticut Middle School Track and Field Championship Meet and knowingly assume any and all risks of loss, damage to my person or property, injury (including death), both foreseen and unforeseen, of my attendance at and participation in the 4th Connecticut Middle School Track and Field Championship Meet, from any cause whatsoever, including the fault or negligence of Releasees (as defined below). I, for myself, my heirs, personal representatives and assigns do hereby release, waive, discharge and covenant not to sue USA Track & Field, Inc., the local USATF Association, the Meet Administrators and Officials, the Facility, their respective officers, directors, employees, agents and volunteers (collectively "Releasees") from all liability, loss, claims, demands, possible causes of action, court costs, settlement costs and fees, attorneys fees and any other expenses arising from any claim or lawsuit that may arise from any loss, damage or injury (including death) to me or my property resulting from or arising in connection with, or related to, my attendance at or participation in the 4th Connecticut Middle School Track and Field Championship Meet. In the event that I am injured, I hereby consent to the provision of necessary and appropriate emergency medical treatment.· By entering this competition, I grant the 4th Connecticut Middle School Track and Field Championship Meet a limited license to use my name, likeness, image, voice, video, athletic performance, biographical and other information, in any format whatsoever, and to distribute, broadcast and exhibit these without charge, restriction or liability, but only for the purposes of advertising or promoting the sport of Athletics. In no event, however, will such usage constitute an endorsement of any product or service without my specific written consent.____________________________________________ SCHOOL NAME: _____________________________________________
PRINT NAME OF ATHLETE
____________________________________________DATE: _____________________
Signature of ATHLETE
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Signature - PARENT / GUARDIAN (Must be signed if athlete is under 18 years of age.)
-A USA Track & Field Sanctioned Event -