SPACE NEEDLE VOLLEYBALL FOUNDATION CONSENT, WAIVER AND RELEASE OF LIABILITY FORM
Participant: I approve of the leaders who will be in charge of this program, realizing that they are serving to the
best of their abilities and in consideration of the benefits to be derived by the participants concerned.
I acknowledge there is an inherent risk of serious injury and potential death associated with vigorous exercise,
competitive play, related physical training activities, and the use of sporting equipment. With full understanding
of the potential risks, I hereby assume the risks of participation, in whatever capacity, in any and all Space
Needle Volleyball Foundation sponsored events. I hereby take the following actions for my executors,
administrators, heirs, next of kin, successor assigns and myself:
1. I hereby voluntarily waive, release and discharge from any and all claims of liabilities for death or personal
injury or damages of any kind, which arises out of or related to my participation in, or any traveling to and
from a Space Needle Volleyball Foundation approved event, the directors, Space Needle Volleyball
Foundation, AAU Youth Foundation, Shoreline Community College, The City of Shoreline, The City of
Seattle, Seattle Public Schools, Seattle Parks and Recreation and the sponsoring institutions for any and all
causes or injuries which may arise in connection with this activity, except that which is the results of gross
negligence and/or wanton misconduct of Space Needle Volleyball Foundation officers, directors, employees,
representatives, and agents of any of the above, and
2. I agree not to sue any of the persons or entities listed above for any of the claims or liabilities that I have
waived, released or discharged herein; and
3. I indemnify and hold harmless the persons or entities mentioned above from any claims made or liabilities
assessed against the persons or entities listed above as a result of my actions; and
As evidenced by my signature, I affirm I have read the above statements and understand that I and/or my parent
or guardian on behalf of myself, because I am seventeen years of age or younger, have given up substantial
rights by signing this release and do sign it voluntarily.
Participant’s Printed Name
Participant’s Signature
Date Signed
Parent of a Participant seventeen years of age or younger must read the entire document and sign
below.
I, the parent or legal guardian of the participant of minority age named herein represent that I have the legal
capacity and authority to act for and on behalf of the minor named herein and hereby execute the foregoing
Waiver and Release for and on behalf of said minor. I hereby bind myself, the minor and all other assigns to the
terms of this waiver and Release. I agree to indemnify and hold harmless the persons or entities mentioned
above for any claims and liabilities assessed against them as a result of any insufficiency of my legal capacity or
authority to act for and on behalf of the minor in the execution of this Waiver and Release.
I fully consent to my son/daughter to participate and travel to and from events or activities sanctioned by Space
Needle Volleyball Foundation including, but not limited to tryouts, practice, tournament, instructional camp,
and/or educational clinic. I also certify that s/he is physically fit to engage in the activities described above. I
hereby authorize emergency medical/dental care to be given in the event my daughter should be injured. I
understand I shall be notified of emergency treatment as soon as possible.
Parent/Guardian’s Printed Name
Parent/Guardian’s Signature
Date Signed
Area Codes and Phone Numbers:
Note: Please remember that without this signed form, you will not be allowed to participate.
SVF Release of Liability form