ICOB Youth FC – Waiver Form

Published on:

July 16, 2025

Name

First

Last

Date of Birth

Parent/Guardian Name

Parent/Guardian Email

Gender

Parent/Guardian Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Player Conduct Expectations

I agree that my child will use respectful language at all times, listen to team leaders and volunteers, refrain from rough or unsafe behavior, and represent the community and masjid with good character.

Medical conditions

Please list any medical conditions, allergies, or concerns we should be aware of.

Medications Taken Regularly

Emergency Medical Care Authorization

In case of a medical emergency, I give permission for ICOB FC coaches or volunteers to seek emergency medical treatment for my child, and I agree to be responsible for any resulting expenses.

Cardiac Emergency Clause

I acknowledge that while rare, cardiac emergencies may occur. I understand: ICOB FC coaches are not medical professionals, there may not be an AED available at all events, 911 will be contacted in serious emergencies, and First aid and CPR may be provided to the best of their ability without liability.

Assumption of Risk

I understand that participation in soccer involves physical activity and potential risks of injury, including but not limited to sprains, concussions, fractures, dehydration or heat exhaustion, allergic reactions, breathing issues, sudden cardiac arrest (SCA), heart attack, and other injuries. I voluntarily assume all risks associated with my child’s participation.

Release of Liability

I release and hold harmless ICOB FC, its volunteer coaches, the Islamic Center of Bothell (ICOB), and associated personnel from any claims of liability, injury, or damage that may arise during participation in team activities.

Consent to Participate

I, the parent/guardian of the above-named participant, give permission for my child to participate in all ICOB FC soccer-related activities, including practices, scrimmages, and team events. I understand that this program is led by volunteer youth coaches and not professional staff.

Signature

Clear Signature

Taken and Participate

Full Name

Name of the person signing the form

Date of Signature