AMPT YOUTH FOOTBALL
CAMP WAIVER FORM
In consideration of being allowed to participate in AMPT Youth Football Camps, the undersigned acknowledges, appreciates, certifies and agrees that:
My participation includes possible exposure to and illness from infectious diseases, including but not limited to MRSA,
influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness, injury,
and death does exist.
If I have a pre-existing health condition, exposure to COVID-19, or any other infectious disease may be more likely to cause serious illness, injury, or death;
AMPT Youth Football Camps cannot ensure that all other participants, including coaches and volunteers, are taking
precautionary measures to mitigate risks to ensure the health and safety of other participants, coaches, and volunteers, and therefore, participation in a AMPT Youth Football Camp involves risk of exposure to infectious disease; and,
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 participation; and,
I certify that I have not recently tested positive for, and am not exhibiting symptoms of COVID-19, which include a cough,
shortness of breath or difficulty breathing, loss of taste or smell, headache, chills, muscle or body aches and/or sore throat.
I certify that I do not have a household family member/roommate who has recently tested positive for or exhibited the
above-referenced symptoms of COVID-19.
I willingly agree to comply with all recommendations provided by AMPT Youth Football Camps to ensure safe play. If, however,
I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and
bring such to the attention of the nearest coach, staff member or volunteer, or official immediately; and,
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD
HARMLESS Nick Shafnisky, AMPT Youth Football Camp and their partners, officers, officials, agents, and/or employees, other
participants, volunteers, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to
conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, INJURY, DISABILITY, DEATH, or loss or damage
to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent
permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IF FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.