Hempfield-Penn Legacy Rugby Football Club - CONSENT, WAIVER, AND RELEASE
I, the Player, or the Player named above (a minor), has my permission to participate in the Hempfield-Penn Legacy
Rugby Football Club program.
I acknowledge (indicate one):
PLAYER IS OVER 18. The person executing this Waiver is the Player.
PLAYER IS UNDER 18. The person executing this Waiver is Player's parent or legal guardian.
PLAYER IS UNDER 13. The person executing this Waiver is Player's parent or legal guardian. Hempfield-Penn
Legacy Rugby may/will not use any personally identifiable information of Player without express consent of
Player's parent or legal guardian.
In consideration for Hempfield-Penn Legacy Rugby acceptance of Player's registration, and before participating in a
Hempfield-Penn Legacy Rugby program or participating in any activity on a Hempfield-Penn Legacy Rugby
owned/leased facility, I agree to the following on behalf of Player, myself, and my family:
- There are inherent risks in participating in the sport of rugby, including serious injuries and even death. These risks
can happen, regardless of the level of care taken by the participant and/or the organizers.
- I knowingly and freely assume all risks of personal injury, property damage, or any other loss while participating in
all activities related to Player's participation in the program, even if due to negligent behavior of Hempfield-Penn
Legacy Rugby and/or its members, staff, club contractors and representatives, or officers.
- I agree that the Player will be bound by and comply with the rules and regulations of Hempfield-Penn Legacy Rugby
and the program and will be subject to exclusion in the event of noncompliance, as determined necessary by
Hempfield-Penn Legacy Rugby, in their sole discretion.
- I hereby authorize Hempfield-Penn Legacy Rugby officers and coaches, if after a reasonable attempt has been
made to reach a parent, guardian, or emergency contact to obtain consent, or if sound medical practice decrees
that there is not time to make such an attempt, to consent to any emergency medical treatment. I acknowledge that
the registration and registration fee do not include accident insurance coverage. I agree to pay for any such
treatment and to reimburse Hempfield-Penn Legacy Rugby for all costs and expenses.
- Intending to be legally bound, I hereby for myself and my family, heirs, and representatives waive and release
Hempfield-Penn Legacy Rugby and their agents, representatives, organizers, affiliated organizations, sponsors,
employees and associated personnel, including owners of fields or facilities, from any and all claims or rights to
damages for injuries or losses suffered by the player, directly or indirectly, in training for, or traveling to and from,
or participating in Hempfield-Penn Legacy Rugby related to any and all injury, disability, or death, whether arising
from negligent behavior or otherwise, to the fullest extent permitted by law.
- I agree to allow Hempfield-Penn Legacy Rugby to photograph and video and use Player's likeness in any future
promotional literature without compensation. FOR PLAYERS UNDER 13, pursuant to the Children's Online Privacy
Protection Act ("COPPA"), I consent and authorize Hempfield-Penn Legacy Rugby to display my child's photograph
or video on their websites and on the website of any third party with which Hempfield-Penn Legacy Rugby has a
business relationship related to the program.
- I intend to provide as broad and inclusive a release of liability as permitted by law and if any portion hereof is held
invalid, I agree that the remaining terms shall continue in full legal force and effect.
Penn Legacy/UYSA Rugby Policy on Concussion Procedure and Protocol:
Go to this site and read the concussion fact sheet for parents/guardians: