This form & waiver are designed for any and all activities and events that this participant engages in through his/her participation in Stamford Rugby Club from 1/1/2023 through 12/31/2023. This includes practices, training, matches, games, competitions, tournaments, and all activities and events that are connected with his/her participation in Stamford Rugby Club. This form and waiver must be completed by the legal parent/guardian of the participant prior to participation.

Participation Waiver

I am fully aware of, and appreciate, the risks, including the risk of serious injury, as well as other damages and losses, associated with participation in rugby activities and events, including but not limited to: practices, training, matches, games, competitions, tournaments, and other rugby events. I agree on behalf of myself, my heirs and personal representatives, that Stamford Rugby Club, as well as agents, officers and directors of those organizations, and any towns, schools, and/or organizations that provide usage of field space with respect to these Rugby activities and events, together with any coaches, officials, volunteers, and employees working in connection with these rugby events, and any rugby membership organizations in which Stamford Rugby Club is a member, shall not be held liable for any injury, loss of life or other loss or damage as a result of my child’s participation in these rugby events and activities.

I attest that my child has health insurance.

I attest that my player son/daughter has received a physical examination by a licensed medical doctor and has been found physically capable of participating in the sport of rugby. If my child has a medical/physical issue that could impact his/her play in rugby, I will provide additional written notice, setting forth any specific issue, condition, or ailment, in addition to what is specified above, that my child has or that may impact my child's participation in the rugby program. I give my consent to have a trainer and/or licensed medical doctor or dentist provide my son/daughter with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such

I hereby give my consent for my child to participate in rugby training and activities with Stamford Rugby Club.

Stamford Rugby Club, Inc. has my permission to use my or my child’s photograph or other media images such as videos publicly to promote the club. I understand that the images and videos may be used in print publications, online publications, presentations, websites, and for social media purposes. I also understand and agree that no royalty, fee or other compensation shall become payable to me by reason of such use.

By signing below, I agree to the aforementioned participation consent form.

Stamford Rugby Club

2023 Feb 11 Youth Rugby Clinic (Ages 6-14)