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2. 
4. This waiver is for anyone 18 and older participating in the adult soccer league at New Century Fieldhouse. This wavier/form must be completed before participating in any league games. All information below is required, and may be shared with the local health department, if a Covid-19 outbreak occurs at NCF for contact tracing purposes.
8. CONTACT INFO
10. Participant's Name*
11. Phone #*
13. Address*
14. Email*
16. City*
17. State*
18. Zip*
20. Soccer Team Name*
21. Soccer Team Manager*
25. Waiver Statement
    WAIVER RELEASE STATEMENT: The undersigned states that he/she understands that the Johnson County Park and Recreation District is not and shall not be responsible for or liable for any illness, injury or death to person or damage to property including but not limited to illness, injury, or death arising from exposure to the Novel Coronavirus (COVID-19), resulting from the program in which the undersigned is enrolling or being enrolled or from his/her participating in said program, and the participant and the undersigned, if the participant is a minor or under other legal disability, hereby forever releases and holds harmless the said Johnson County Park and Recreation District, its employees, agents and representatives from any and all claims of any kind, including but not limited to claims arising from exposure to the Novel Coronavirus (COVID-19), that the participant, or the undersigned or their respective heirs, executors, administrators, or assigns may have or claim to have resulting from participation in said program. NOTICE: By participating in this program you hereby acknowledge the Johnson County Park & Recreation District can and may photograph and/or video tape program participants and then use such images, without payment or any other consideration, for purposes of publicizing District parks, facilities, programs or services, or for any other lawful purpose.
27. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your waiver form will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
29. Electronic Signature*
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit Submit and Print

* indicates a required field