Player Name_______________________________ Level: (circle) U10 U12 U14 U16

U19 East Shore

2020 Stryker Tournament Waivers

This PDF contains all of the local tournament player release/waiver forms that we have to date. You must fill
out ALL of the forms for EVERY tournament – whether you think you will be attending or not (some
tournaments are for only U14 and older, but we want to have all waiver packets completed by all players).
When turning in forms make sure they are stapled, paper clipped or in an envelope with a first and last name
on each sheet.

IMPORTANT!!! Please make sure that if you print on both sides of the paper that you don’t have parts of two
different waivers on the same page. Each waiver has to be turned in to the tournament organizer and we
don’t want to have to make copies. You can double side waivers that have multiple pages. Please staple all of
the waivers together and in order when they are complete. Listed below are the waivers and page numbers to
help you in the printing and turning in the waivers.

Waivers included in this packet:

• Gilroy Indoor-pg. 2
• Berkeley pgs. 3-5
• Stanford pgs. 6-7
• Gilroy Outdoor-pg. 8

Fill out ALL of the forms in this packet. They are due by Sunday, Feb. 16th. You can bring them
to practice or mail them to:

Stryker Field Hockey Club

4566 Napa River Ct.
San Jose, CA 95136

NOTE: Do not email these forms as they all have to be printed out and turned in to
tournament organizers. We will not be printing individual player’s forms. You will need to
print them and turn them in on your own

NOTE: Players will not be placed on any tournament teams if completed waivers have not been turned in by
the due date above. We will not “chase” you for forms. Also, the Davis and San Francisco tournament waiver
will be online so we will send instructions on how to fill out these waivers.

An additional tournament or two may be added as we go through the season. We will distribute any additional
waiver forms needed as we enter teams in those tournaments.
 Infinity Sports Club
Tournament Waiver Form
Event: Infinity Indoor Tournament - Fools Fest
Date of Event: March 7, 2020 and/or March 8, 2020
Participant Information:

Name: _________________________________Date of Birth: __________________ Gender: B / G (circle one)

Parents Name: __________________________________ Parents Email: __________________________

Parents Cell #: __________________________________ Alt. Cell #: _____________________________

Additional Emergency Contacts:

Name:____________________________ Phone Number: __________________ Relationship:_____________

Name:____________________________ Phone Number: __________________ Relationship:_____________

Participation Waiver

I am aware that participation in Infinity Field Hockey or Soccer programs or the use of Field hockey/Soccer
equipment creates risk of injury, and I, on behalf of myself and the participant's, knowingly and freely assume
all such risks, both known and unknown, even if arising from the negligence of others; and,

I, for myself and the participant(s) listed above, and our respective heirs, assigns, administrators, personal
representatives, and next of kin, hereby release and hold harmless, Infinity Sports Club and their affiliates,
officers, members, volunteers, agents, employees, other participants, and sponsoring agencies from and
against any and all claims, injuries, liabilities or damages arising out of or related to participation in any and all
programs of Infinity Sports Club and/or the use of any field equipment.

Parent/Guardian Signature _____________________________________________

Print Name__________________________________________________________

Date: _________________________________

2
 US SPORTS CAMPS - HEALTH & RELEASE FORM-BERKELEY
*MAIL ALL FORMS PRIOR TO CLINIC*
(You will not be admitted to camp without this form, completed and signed on both pages.)

CAMPER’S NAME_________________________________________________________________________
SPORT: Field Hockey CAMP LOCATION: U.C. Berkeley CAMP DATES: March 14-15 and/or May 17

Sex: _____Birthday:__________ Age:_____ Weight:_____ Height:______

Address City State Zip_____________________________________________________________________________________________________

Home Phone ( )_________________________Work Phone ( )__________________________ Cell Phone ( )_________________________

E-Mail__________________________________________________________________________________________________________________

My Phone Number while named camper is at camp (if different from above) ( )_______________________________

Person to contact in the event I cannot be reached_____________________________________________Phone number ( )__________________

HEALTH & GENERAL HISTORY
If the camper should be restricted from any activity please note:____________________________________________________________________

If the camper will be taking medication during camp, please indicate name of drug and dosage:___________________________________________
Please identify any medical condition or medical history that would require special attention:

I hereby certify that the named camper is in good health and fully able to participate in all activities of the Sports Camp and that
I know of no restrictions, physical impairments, or any other facts, which in any manner limit his/her participation in such a
program:
Signed:_________________________________ Date:____________________

Please circle those illnesses or conditions that the camper has had:
German Measles Measles Mumps Asthma Chicken Pox Pneumonia Diabetes High Blood Pressure
Immunizations Allergies Drug Reactions Comments:
Type Yes/No Type Yes/No Type Yes/No
Tetanus Toxiod Hay Fever Sulpha
Polio Vaccine Asthma Penicillin
Measles Eszema Antibiotics (type)
Rubella Insect Stings Aspirin
Mumps Nuts Other
Other Other

Physician's Name: ___________________________________________________Telephone ( )_______________________________________

HEALTH INSURANCE INFORMATION

Carrier Name: ______________________________________________________Policy Number:________________________________________

Policy Holder Name: _________________________________________________Policy Holder Date of Birth:_____________________________

I, the parent (guardian) of _________________________________________, give permission for the named camper to receive emergency medical
or surgical treatment and hospitalization if necessary. I understand that good faith attempt will be made to contact me, or the emergency contact
named above, before taking this action. I will be financially responsible for any medical attention needed during camp or resulting from an injury
received at camp. My medical insurance shall be the insurance coverage for any medical treatment. I further agree that my child can receive over the
counter remedies. (Tylenol, Sudafed, etc.)

Please initial this box if you DO NOT want your child to receive over the counter medications.
I HAVE READ THE REGISTRATION PACKET AND FULLY UNDERSTAND OUR OBLIGATIONS STATED THEREIN AND ALSO THE
RIGHTS OF US SPORTS CAMPS, INC., AND HERBY AGREE TO ACT IN ACCORDANCE. For good and adequate consideration, which I
acknowledge I have received, I hereby grant, release, and quit claim to USSC royalty free the right and authority to use, reproduce,
and distribute, quoted material, my child’s photograph, likeness, recorded voice or videotaped filmed
appearances (the "Materials") for promotional and advertising purposes as USSC in its sole discretion will deem
appropriate. I also grant US Sports Camps, Inc. permission to give Nike, Inc. camper’s name, address, date of birth,
gender, phone, electronic mail address and sports interests for direct marketing purposes.
The undersigned further expressly agrees that the attached waiver and assumption of risks agreement is intended to be as broad and inclusive as is
permitted by law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and
effect.
Signed:______________________________________________________________ Date:______________________________________________
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 RELEASE OF LIABILITY – READ BEFORE SIGNING
1. In consideration of my minor child/ward ____________________________(“my child”) being allowed to participate in this sport
camp program, its related events and activities, I, the undersigned, acknowledge, appreciate, and agree that: The risk of serious
injury from the sports activities involved in this program is always present due to the nature of the sport (s); and there are also risk
of injury from such outside camper activities to which you may consent, and
2. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and
unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for
my child’s participation; and
3. I willingly agree to comply with the program’s stated and customary terms and conditions for my child’s participation. If,
however, I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will
remove my child from participation and bring such to the attention of the nearest official immediately; and
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY,
AND HOLD HARMLESS the Camp, US Sports Camps, Inc., (USSC), NIKE, Inc., their officers, directors, officials, agents,
owners and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of
premises used for activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, OR LOSS
OR DAMAGE TO PERSON OR PROPERTY, regarding my child and/or arising from his/her activities, WHETHER ARISING
FROM NEGLIGENCE OF THE RELEASEES OR OTHERWISE, except for willful misconduct, or otherwise to the fullest
extent of the law.
I HAVE READ THIS HEALTH FORM AND RELATED CERTIFICATIONS, THE RELASE OF LIABILITY AND
ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND THEIR TERMS, UNDERSTAND THAT I
HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY
WITHOUT ANY INDUCEMENT.

Dated:__________________ Parent or Guardian:____________________________________________________________________

Agreement to Arbitrate Disputes
IN THE EVENT OF ANY DISPUTE PERTAINING TO ANY PROVISION OF THIS AGREEMENT, OR PERTAINING
TO THE SERVICES RENDERED PURSUANT TO THIS AGREEMENT, OR IN ANY WAY RELATED TO ATTENDANCE AT
THIS CAMP, INCLUDING ANY CLAIM FOR PERSONAL INJURY OR OTHER LOSS, EMPLOYEE, OR AGENT OF THE
CAMP OR OF ANY FOREGOING ENTITY, EACH PARTY HERETO AGREES TO SUBMIT TO BINDING ARBITRATION TO
RESOLVE SUCH DISPUTES, BY CLAIM FILED, BEFORE JAMS IN SAN FRANCISCO, CALIFORNIA, TO BE ARBITRATED
HERE OR SUCH OTHER VENUE AS DEEMED APPROPRIATE BY THE JAMS ARBITRATOR, SUCH ARBITRATION TO
PROCEED UNDER THE JAMS RULES.
In the event either party to this agreement incurs any expense as a result of the other party’s failure to comply with any provision of
this agreement, the non-complying party shall be liable for reimbursement of any and all such expenses or attorney fees directly or
indirectly related to failure to comply. In the event any legal action or proceeding occurs which is in any manner related to or
pertaining to this agreement, attempting to challenge in a non-arbitral forum such as a court of law the validity or application of this
agreement, the party who substantially prevails in that court or non-arbitral proceeding shall be entitled to receive reasonable costs of
such action or proceeding including attorney’s fees. In the arbitration itself, each party shall bear its own attorneys’ fees. The
following disclosures are intended to help you thoroughly understand the significance of agreeing to arbitrate any controversy, or
claim, or issue in any controversy or claim which may arise between the undersigned client and the attorney:
A) ARBITRATION SHALL BE FINAL AND BINDING ON THE PARTIES.
B) THE PARTIES HERETO ARE WAIVING THEIR RIGHT TO SEEK REMEDIES IN COURT, INCLUDING
THE RIGHT TO JURY TRIAL.
C) PRE-ARBITRATION DISCOVERY IS GENERALLY MORE LIMITED THAN AND DIFFERENT FROM
COURT PROCEEDINGS.
D) THE ARBITRATOR’S (S) AWARD IS NOT REQUIRED TO INCLUDE FACTUAL FINDINGS OR LEGAL
REASONING AND ANY PARTY’S RIGHT TO APPEAL OR TO SEEK MODIFICATION OF RULINGS BY
THE ARBITRATOR (S) IS STRICTLY LIMITED.
E) THE ARBITRATOR OR PANEL OF ARBITRATORS WILL TYPICALLY INCLUDE AN ATTORNEYOR
JUDGE, ACTIVE OR RETIRED.
BY SIGNING BELOW, YOU ARE SIGNIFYING UNDERSTANDING AND ACCEPTANCE OF THE PROVISIONS
OF THIS AGREEMENT.
I hereby certify that the above-mentioned participant is in good health and fully able to participate in all activities of the
Camp. By signing below, I am stating that I am also aware of and accept the risk inherent in the program activity. By
signing below, I agree as well to hold harmless and indemnify US Sports Camps, Inc., NIKE, Inc., their officers, directors,
owners, officials, agents and employees, from any and all liability, loss, damages, costs, refunds or expenses which are
sustained, incurred or required out of the actions of my dependent in the course of the camp.

Dated:______________________________________________________ Parent or Guardian:________________________________

4
 University of California: Waiver of Liability, Assumption of Risk, and Indemnity Agreement

In consideration of being permitted to participate in any way in the camps that I have enrolled my child in, as listed on the
Registration Form; hereinafter called "The Activity," I, for myself, my heirs, personal representatives or assigns, do
hereby release, waive, discharge, and covenant not to sue The Regents of the University of California, its officers,
employees, and agents (collectively the “Releasees”) from liability from any and all claims including negligence,
resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to,
participation in The Activity.

I also agree to INDEMNIFY AND HOLD the Releasees HARMLESS from any and all claims, actions, suits, procedures,
costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in The Activity
and to reimburse them for any such expenses incurred.

Dated: _______________________Parent or Guardian:______________________________________________________________

University of California: Camps Program Participant Agreement

I give permission to USSC to transfer the following data to the University: my name, contact information, phone number,
and camp session(s) attended; and if my child is a camp participant, my child’s name, contact information and phone
number (if different from mine), date of birth, and gender. I further give permission to the University to use such data in
furtherance of its marketing, development, and promotion efforts, and other purposes consistent with increasing the profile
and reach of the Intercollegiate Athletics Department.”
In consideration of being permitted to participate in any way in the camps that I have enrolled my child in, as listed on the
Registration Form; hereinafter called "The Activity," I, for myself, my heirs, personal representatives or assigns, do hereby
release, waive, discharge, and covenant not to sue The Regents of the University of California, its officers, employees, and
agents (collectively the “Releasees”) from liability from any and all claims including negligence, resulting in personal
injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in The
Activity.

I also agree to INDEMNIFY AND HOLD the Releasees HARMLESS from any and all claims, actions, suits, procedures,
costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in The Activity
and to reimburse them for any such expenses incurred.

Dated: ________________________Parent or Guardian:____________________________________________________________

5
 2019 Sports Camp at Stanford University
Assumption of Risk Release of Claims, Indemnity and Hold Harmless Agreement
and Photo/Video Release form

The parties to this Release are ______________________________ (Participant), ____________________________ (Participant 's parent(s) or legal
guardian, if Participant is under 18, all referred to hereafter jointly and severally as "Participant") and the Board of Trustees of the Leland Stanford
Junior University its officers, trustees, faculty, agents, contractors, representatives, volunteers, students and employees (collectively referred to
hereafter as "Stanford”) for the 2019 ___________ Camp at Stanford University (“Stanford Summer Program”).

Participant is a voluntary participant in the Stanford Summer Program. Participant understands and agrees that such activities may be dangerous.
Participant is apprised that Stanford will not be subject to claims or suit to be made by or on behalf of Participant or Participant’s heirs,
representatatives or assigns as a consequence of Participant’s participation in the Stanford Summer Program.

Assumption of Risk. Participant expressly understands and agrees that the Stanford Summer Program presents risks to Participant and/or her/his
property. These risks can include, among others (by way of example and without limitation): disease risks; injury to the muscular, skeletal or nervous
systems; injury to internal organs; scratches, bruises, contusions; loss or damage to sight, teeth or hearing; paralysis; concussions; brain damage;
other serious injury and/or death. Participant is responsible for researching and evaluating the risks he/she may face and is responsible for his/her
actions. Any activities that Participant may take part in, whether as a component of the Stanford Summer Program or separate from it, will be
considered to have been undertaken with Participant's approval and understanding of any and all risks involved.

It is Participant’s intention that this assumption of all risks shall be legally binding and a complete bar to Participant, Participant’s heirs,
personal representatives, relatives and assigns. This assumption of risk applies to all activities arising out of, associated with or resulting
directly or indirectly from Participant’s participation in the Stanford Summer Program, including but not limited to those risks listed above.

Participant further recognizes, understands and agrees that neither Stanford nor the Stanford Summer Program assumes responsibility for any liability
related to damage or injury that may be caused by Participant’s negligence or willful acts committed prior to, during or after participation in the Stanford
Summer Program, or any liability, damage or injury caused by others, including other participants.

Adherence to Standards. Participant understands and agrees to abide by all Stanford policies, rules, and regulations and to all the Stanford Summer
Program’s rules and regulations.

Release of Claims. In consideration of being accepted into and/or participating in the Stanford Summer Program, Participant agrees for Participant
and on behalf of Participant’s heirs, executors, administrators, employers, agents, representatives, insurers, and attorneys, to release and discharge
Stanford and Stanford Summer Program of and from and acknowledges that there is no responsibility on the part of Stanford for any and all claims
which may arise from any cause whatsoever, including any negligent act or omission by Participant, Stanford or others.

Participant intends that both the assumption of risk and the release of claims be complete defenses to any and all actions, claims or demands that
Participant, Participant’s heirs or legal representatives have or may have for injuries to person or property, including death, as a result of activities for
which the Participant has assumed risks and/or released claims.

Indemnification and Hold Harmless. Participant hereby agrees to indemnify, defend, and hold Stanford and Stanford Summer Program harmless
from any injury, loss or liability whatsoever including reasonable attorneys' fees and/or any other associated costs, from any action, claim, or demand
that Participant, Participant’s heirs or legal representatives, has or may have for any and all personal injuries Participant may suffer or sustain,
regardless of cause or fault as a result of, arising out of, associated with, or resulting directly or indirectly from Participant’s voluntary participation in or
decision to participate in the Stanford Summer Program, travel to and from the Stanford Summer Program and any and all related activities, on or off of
Stanford’s campus. This Indemnification and Hold Harmless Agreement is intended to be all encompassing.

Physical Condition and Insurance. Participant attests that she/he is physically and mentally capable of participating in, and has no known health
restrictions that might jeopardize her/his safety or health or the safety or health of others during their participation in the Stanford Summer Program.
Participant gives permission for Stanford or its representative to provide immediate and reasonable emergency care should it be required. Participant
agrees to be solely responsible for payment in full of all costs of medical care she/he may receive.

Severability. It is understood and agreed that, if any provision of this Agreement or the application thereof is held invalid, the invalidity shall not affect
other provisions or applications of this Agreement which can be given effect without the invalid provisions or applications. To this end, the provisions of
this Agreement are declared severable.

6
Governing Law and Venue. This Agreement shall be construed in accordance with, and governed by, the laws of the State of
California. The venue for any action arising out of this Agreement shall be the County of Santa Clara, State of California. The
parties agree to submit to jurisdiction in Santa Clara County, California.

Construction and Scope of Agreement. The language of all parts of this Agreement shall in all cases be construed as a whole,
according to its fair meaning, and not strictly for or against any party. This Agreement is the only, sole, entire, and complete
agreement of the parties relating in any way to the subject matter hereof. No statements, promises, or representations have been
made by any party to any other, or relied upon, and no consideration has been offered or promised, other than as may be expressly
provided herein. This Assumption of Risk, Release of Claims, Indemnification, and Hold Harmless and Agreement supersedes any
prior or contemporaneous written or oral understandings or agreements between the parties.

Photo/Video Release. I hereby authorize Stanford University to use, reproduce, and/or publish photographs, video, other digital
representations, and/or audio that may pertain to Participant , including Participant’s image, likeness and/or voice (collectively
“Participant”). Participant hereby authorizes Stanford University to edit, alter, copy, exhibit, publish or distribute the Works for any
lawful purpose. Participant waives any right to inspect or approve the finished product, including written copy, that may be created
in connection therewith. Participant also agrees that by signing below, Participant releases Stanford University any and all of its
representatives from any and all monetary obligations or payments to me or any of my authorized representatives for use of video,
films, photographs, image, other digital representation and/or voice of Participant . Participant understands that this material may
be used in various publications, public affairs releases, recruitment materials or for any other purpose consistent with the mission of
Stanford University. This material may also appear on one or more Stanford University websites. This authorization is irrevocable
and Participant hereby holds harmless and releases and forever discharges Stanford University and its representatives from all
claims, demands, and causes of action which Participant , Participant’s heirs, representatives, executors, administrators, or any
other persons acting on Participant’s behalf or on behalf of Participant’s estate have or may have by reason of this authorization.

Goggle Use. Participant acknowledges that there is conflicting information about benefits and risks related to the use of goggles
when participating in the Program. Participant understands that Stanford takes no position on and makes no recommendation
regarding the use of goggles and that Stanford neither recommends or discourages the use of goggles. Participant assumes all
risks associated with the decision to use or not use goggles when participating in the Program.

Please Initial to indicate whether you are the parent or legal guardian of the minor
(_______)Parent (_______) Legal Guardian
_________________________________________________________________

Participant acknowledges that he/she has read this Assumption of Risk, Release of Claims, Indemnification and Hold
Harmless Agreement, understands its meaning and effect, and agrees to be bound by its terms.

Participant’s Name Printed_____________________________________________________Date:________________________

Signature of Custodial Parent or Legal Guardian (if Participant under 18) ____________________________________________

Custodial Parent of Legal Guardian Name Printed________________________________________________________________

Address_________________________________________________________________Phone Number_____________________

7
 Infinity Sports Club
Tournament Waiver Form
Event: Infinity Outdoor Tournament – Spring Fling
Date of Event: May 9, 2020
Participant Information:

Name: _________________________________Date of Birth: __________________ Gender: B / G (circle one)

Parents Name: __________________________________ Parents Email: __________________________

Parents Cell #: __________________________________ Alt. Cell #: _____________________________

Additional Emergency Contacts:

Name:____________________________ Phone Number: __________________ Relationship:_____________

Name:____________________________ Phone Number: __________________ Relationship:_____________

Participation Waiver

I am aware that participation in Infinity Field Hockey or Soccer programs or the use of Field hockey/Soccer
equipment creates risk of injury, and I, on behalf of myself and the participant's, knowingly and freely assume
all such risks, both known and unknown, even if arising from the negligence of others; and,

I, for myself and the participant(s) listed above, and our respective heirs, assigns, administrators, personal
representatives, and next of kin, hereby release and hold harmless, Infinity Sports Club and their affiliates,
officers, members, volunteers, agents, employees, other participants, and sponsoring agencies from and
against any and all claims, injuries, liabilities or damages arising out of or related to participation in any and all
programs of Infinity Sports Club and/or the use of any field equipment.

Parent/Guardian Signature _____________________________________________

Print Name__________________________________________________________

Date: _________________________________