Liability Waiver and Medical Release 2025-26 (complete once per school year)

indicates a required answer

This form must be electronically signed to complete your registration.

The electronically signed, being the parent(s) or legal guardian of the following children:

1. *	1st Child's Full Legal Name (First Middle Last):

2. *	1st Child's Date of Birth (MM/DD/YYYY):

3.	2nd Child's Full Legal Name (First Middle Last):

4.	2nd Child's Date of Birth (MM/DD/YYYY):

5.	3rd Child's Full Legal Name (First Middle Last):

6.	3rd Child's Date of Birth (MM/DD/YYYY):

7.	4th Child's Full Legal Name (First Middle Last):

8.	4th Child's Date of Birth (MM/DD/YYYY):

9.	5th Child's Full Legal Name (First Middle Last):

10.	5th Child's Date of Birth (MM/DD/YYYY):

LIABILITY WAIVER AND MEDICAL RELEASE

NHAC does not provide any type of health or accident insurance for injuries or illness incurred by your child. We encourage all families to have health and accident coverage on their child prior to participation in any NHAC sponsored activity. Please read your personal/family insurance policy to determine if you need to supplement your primary health insurance.

I acknowledge that by its nature, participation in athletics includes the risk of injury which may range in severity. Although serious injuries are not common in supervised athletic programs, it is impossible to eliminate the risk. Players can help reduce the chance of injury by obeying all safety rules, reporting physical problems to their coaches, following a proper conditioning program, and inspecting their own equipment daily.

I acknowledge that there are inherent risks associated and accompanied with sports and activities and that my child may be injured as a result of an accident arising out of participation in athletics or activities. If my child is transported by team-sponsored transportation (e.g., chartered bus), I assume all liability for participation and any injury that may result during transport to and from the activity/event.

Some NHAC practices are held on or based at the Swansons’ home, a vintage farmstead, which has inherent risks, including but not limited to old buildings, electric fences, animals, and other hazards. This waiver applies to the athlete and his/her family members and guests who visit the property.

In case of an accident or serious illness, I request to be contacted. If a coach or team representative is unable to reach me, I authorize a coach or designated assignee to make whatever arrangements are necessary. It is understood that this authorization is given in advance of any specific diagnosis or required treatment and is given to encourage a hospital and/or physician(s) to exercise their best judgment as to the requirements of such diagnosis and treatment in those instances when a parent of the minor is unavailable to provide the necessary consent to treatment.

In consideration for permitting my child named above to participate in sports and/or activities, I release and hold harmless NHAC and/or its coaches and/or representatives from any and all liability including, but not limited to liability for injuries or damages sustained by the individual.

By signing this form, I hereby give permission for my child to participate in athletic programs and activities of the Northwest Homeschool Athletic Cooperative (NHAC).

I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

THE ELECTRONICALLY SIGNED HAS READ THE ABOVE WAIVER AND RELEASE, AND UNDERSTANDS THAT HE/SHE HAS GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGNS IT VOLUNTARILY.

11. *	ELECTRONIC SIGNATURE. Parent/Guardian's full name (First Last):

12. *	Today's date (MM/DD/YYYY):