San Bruno Lowen83 FC Waivers
Concussion Information and Waiver
A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with the force transmitted to the head. They can range from mild to severe and can disrupt the way the brain normally works. Even though most concussions are mild, all concussions are potentially serious and may result in complications including prolonged brain damage and death if not recognized and managed properly. You can’t see a concussion and most sports concussions occur without loss of consciousness. Signs and symptoms of concussion may show up right after the injury or can take hours or days to fully appear. If your child reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right away.
Symptoms may include one or more of the following:
Headaches • Amnesia • “Pressure in head” • “Don’t feel right” • Nausea or vomiting • Fatigue or low energy • Neck pain • Sadness • Balance problems or dizziness • Nervousness or anxiety • Blurred, double, or fuzzy vision • Irritability • Sensitivity to light or noise • More emotional • Feeling sluggish or slowed down • Confusion • Drowsiness • Change in sleep patterns • Repeating the same question/comment • Feeling foggy or groggy • Concentration or memory problems (forgetting game plays)
Signs observed by teammates, parents and coaches include:
Appears dazed • Vacant facial expression • Confused about assignment • Forgets plays • Is unsure of game, score, or opponent • Answers questions slowly • Moves clumsily or displays incoordination • Slurred speech • Shows behavior or personality changes • Seizures or convulsions • Can’t recall events prior to hit • Can’t recall events after hit• Any change in typical behavior or personality • Loses consciousness
What can happen if my child keeps on playing with a concussion or returns too soon?
Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an increased risk of significant damage from a concussion for a period of time after that concussion occurs, particularly if the athlete suffers another concussion before completely recovering from the first one. This can lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with devastating and even fatal consequences. It is well known that adolescent or teenage athlete will often under report symptoms of injuries, and concussions are no different. As a result, education of administrators, coaches, parents and students is the key for student-athlete’s safety.
By checking the Read and Understood check box, I acknowledge that I have read and understood the information regarding concussions that apply to participation in soccer. I acknowledge that I have received this Lowen83 FC handout regarding concussions. I know and understand that I should notify the proper healthcare provider(s) when I suspect my Player may have sustained a concussion. I take full responsibility for notifying the proper healthcare provider and my coach if I think my Player may have a concussion, and I also take full responsibility for any injuries or other problems that might occur to my Player or others as a result of a concussion.
SHOULD A PLAYER BE REMOVED FROM PLAY BECAUSE OF A SUSPECTED CONCUSSION, THE PLAYER WILL NOT BE ALLOWED TO RETURN TO PLAY UNLESS AND UNTIL A CONCUSSION EVALUATION AND RELEASE TO PLAY FORM FOR LICENSED HEALTH CARE PROVIDERS HAS BEEN COMPLETED AND RETURNED TO THE LOWEN83 FC TEAM.
I/We hereby give consent and release, without recompense, for the use of photographs, recordings or videotape taken for the purpose of Lowen83 FC publicity, publications, promotions, or news media coverage of Lowen83 FC activities.
MEDICAL TREATMENT AUTHORIZATION, LIABILITY WAIVER, etc.
PARENT(S)/ GUARDIAN(S) HEREBY GIVE FULL AND KNOWING CONSENT TO HAVE ANY ATHLETIC TRAINER, COACH, TEAM MANAGER, EMERGENCY MEDICAL TECHNICIAN, NURSE, MEDICAL TREATMENT FACILITY, AND/ OR DOCTOR OF MEDICINE OR DENTISTRY OR ASSOCIATED PERSONNEL (COLLECTIVELY, “MEDICAL ASSISTANCE PROVIDERS”) PROVIDE THE PLAYER WITH MEDICAL ASSISTANCE AND/ OR TREATMENT AND AGREE TO BE FINANCIALLY RESPONSIBLE FOR THE COST OF SUCH ASSISTANCE AND/ OR TREATMENT. PARENT(S)/ GUARDIAN(S) HEREBY AUTHORIZE EMERGENCY TRANSPORTATION OF THE PLAYER TO A MEDICAL TREATMENT FACILITY SHOULD A MEDICAL ASSISTANCE PROVIDER CONSIDER IT TO BE WARRANTED. PARENT(S)/ GUARDIAN(S) RECOGNIZE THE POSSIBILITY OF SEVERE PHYSICAL INJURY ASSOCIATED WITH SOCCER, AND HEREBY RELEASE, DISCHARGE AND OTHERWISE INDEMNIFY THE MEDICAL ASSISTANCE PROVIDERS, LOWEN83 FC, LOWEN83 FC AFFILIATED ORGANIZATIONS, THE OWNERS AND OPERATORS OF THE FACILITIES USED FOR THE LOWEN83 FC ACTIVITIES, AS WELL AS THE RESPECTIVE DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, REPRESENTATIVES AND ASSOCIATED PERSONNEL OF ALL THE ABOVE FROM AND AGAINST ALL CLAIMS, LIABILITIES, DAMAGES OR CAUSES OF ACTION ARISING OUT OF OR IN CONNECTION WITH THE PLAYER’S PARTICIPATION IN THE LOWEN83 FC ACTIVITIES (INCLUDING, WITHOUT LIMITATION, PLAYER’S TRANSPORTATION TO/FROM ANY LOWEN83 FC ACTIVITY, WHICH TRANSPORTATION IS HEREBY AUTHORIZED; AND THE MEDICAL ASSISTANCE AND/OR TREATMENT DESCRIBED ABOVE) TO THE MAXIMUM EXTENT PERMITTED UNDER CALIFORNIA STATE LAW. PARENT(S)/ GUARDIAN(S) FURTHER GRANT THE LOWEN83 FC THE RIGHT TO USE THE PLAYER’S NAME, PICTURE AND/ OR LIKENESS IN PRINTED, BROADCAST AND OTHER MATERIAL CONCERNING THE LOWEN83 FC, PROVIDED SUCH USE IS RELATED TO THE PLAYER’S STATUS AS A PARTICIPANT IN LOWEN83 FC ACTIVITIES.
In the event that any Contract provision or (part thereof) is declared by any adjudicator to be illegal, unenforceable, or void, the remainder of this Contract shall continue in full force and effect. This Contract encompasses the entire agreement of the Parent(s)/ Guardian(s) and the Lowen83 FC with respect to the subject matter hereof and supersedes all previous understandings and agreements between the Parent(s)/ Guardian(s) and the Lowen83 FC, whether written or oral, on those subjects.
Each individual signing this Agreement, whether signed individually or on behalf of any person, warrants and represents that he or she has full authority to so execute the Agreement on behalf of the Parents/Guardians on whose behalf he or she so signs and that the other will be bound hereby.
Lowen83 FC Parent Contract
The Lowen83 FC and its member teams believe that competitive soccer is for the kids. Therefore, the Parent(s)/ Guardian(s) and Lowen83 FC willingly enter into this agreement with the shared goal of providing the Player the opportunity to participate in youth soccer in a safe, fun and productive environment.
The Parent(s)/ Guardian(s) hereby confirm that they actively support, and will continue to support, the Lowen83 FC efforts to provide a safe, fun and productive experience for the Player and for all others associated with Lowen83 FC and Lowen83 FC related activities. Toward that end, the Parent(s)/ Guardian(s) take full responsibility for the (in)actions of the Player, themselves, the Player’s other Parent and/ or Guardian, and any of their invited guest(s).
General Behavior Policy:
Parent(s)/ Guardian(s) agree(s) and understand(s) that the Supporters are guests and the former will ensure the following conduct by their Supporters before, during and after all Lowen83 FC activities (e.g., practices, games, other Lowen83 FC events, transportation).
Provide a respectful attitude and act accordingly (e.g., good sportsmanship) towards the game, all players, all players’ (including opponents’) Supporters, Lowen83 FC management, coaches, referees and all others associated with and/or involved with any Lowen83 FC Activity.
Respect the Lowen83 FC management’s authority over the team and any Lowen83 FC event (e.g., by not coaching or criticizing the Player (or any other participating player) from the sideline, during warm-ups or otherwise).
Refrain from the use of alcohol, tobacco or illegal drugs on the playing fields or in the spectator areas around them.
No abusive behavior (either verbal, written, electronic or physical) towards any player, player Supporter, Lowen83 FC management, coach, referee and all others associated with any Lowen83 FC Activity.
Encourage the Player’s and other players’ Supporters to observe these rules.
Supporters will promptly and respectfully follow the direction of the Player’s then senior on-site team official (e.g., coach or team manager) and the head referee (the later alone if any difference in direction). For example, if ejected by a referee, the individual who is asked to leave will remove themselves promptly from the general event area after (as to Parent(s)/ Guardian(s) only, or their designee at the event) a sufficient opportunity to make post-event arrangements with the Player. Anyone who is ejected by a referee will be automatically banned from attending the next scheduled game and can be banned for longer if so determined exclusively by the Conflict Resolution Process ( see” Conflict Resolution Policy” below).
Supporters agree to use good judgment and raise only good faith issues in ways that minimize, wherever reasonably possible, otherwise avoidable negative impacts on the Player, other players, referees, coaches, the Lowen83 FC and all others associated with any Lowen83 FC Activity.
General Team/Refund Policy: Parent(s)/ Guardian(s) agree to the following general administrative items:
While parent/guardian volunteers (e.g., team managers) may provide substantial assistance to the coaches in daily operations, the coaches are the sole recognized authority of the team.
Please note all registration payments are final and are NOT REFUNDABLE. No registration fees will be refunded for any reason whereas a season is prevented by circumstances arising out of forces beyond control, including acts of war, pandemic crisis, natural catastrophes or acts of God (i.e. earthquake, storms). Furthermore, it is also stated that no refund shall be granted in the event of sickness and/or injury to said player.
Once this contract is signed, Parent(s)/ Guardian(s) are obligated to pay the Lowen83 FC fees in full within 15 days of the date of issuance of a written request for such made by a Lowen83 FC representative (unless a pre-signed alternative arrangement has been made).
Parent(s)/ Guardian(s) are obligated to have all players in their charge show up on time and fully prepared to participate actively and safely in all Lowen83 FC Activities.
Parent(s)/ guardian(s) are expected to work in a timely and cooperative manner with team management (usually the team manager being the initial point of contact) regarding requests for information (e.g., scheduling of Lowen83 FC Activities).
Players are generally expected to attend all Lowen83 FC Activities not clearly designated in writing as voluntary, to monitor regularly for all Lowen83 FC communications, and to promptly and sufficiently respond where needed. Schedule conflicts (or other legitimate excuses) must be clearly communicated immediately to both the team manager and coach once known.
Teams (including Player parents/ guardians) will assist in the operations of the Lowen83 FC by participating as needed in activities including, but not limited to: tournament organization, tournament production, fundraisers and administrative functions.
Conflict Resolution Policy/ Zero Tolerance Policy:
Any incidents of asserted serious misconduct including, but not limited to, any alleged serious violation of the General Behavior Policy and the General Team Policy, which are not fully resolved first at the Team management level, will be dealt with exclusively (except for any potentially criminal aspect) by (at any party’s written initiation to), Lowen83 FC Board of Directors at P. O Box 1633, San Bruno, CA 94066 both also requesting acknowledgement of receipt in some written form which the initiator agrees to safeguard copies of and to provide promptly to the Lowen83 FC Board upon request. The Lowen83 FC Board will review the alleged misconduct and alone will determine the appropriate course of action. All parties involved will have an opportunity to present their position including any documentation or witness(es). Either serious single or persistent misconduct will not be tolerated. Decisions issued by the Lowen83 FC Board are final and are not subject to appeal of any kind in any forum. Sanctions imposed by the Lowen83 FC Board may exceed the minimum penalties that are required by the associated league (which may impose its own sanctions in any case). These sanctions may include, but are not limited to: warnings, suspensions or expulsion from the Lowen83 FC. Lowen83 FC management (including coaches) may immediately impose interim sanctions (e.g., suspension) when believed, in good faith, needed for any safety-related reason.
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.
The health and well-being of our staff and players remains our top priority. In order to minimize the risk of COVID-19 entering our environment and spreading among our community, we will only allow staff assigned to work and players scheduled to participate to be in our fields/blacktop. Parents wishing to remain on site can use the outdoor common areas or the parking lot to wait for their child(ren). Players waiting to attend a session will need to maintaining social distance from others the minimum of 6’ feet.
Lowen83 FC has put in place preventative measures to reduce the spread of COVID-19; however, Lowen83 FC cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending Lowen83 FC events could increase your risk and your child(ren)’s risk of contracting COVID-19.
You must notify both the coach and manager if anyone in your immediate family has been in contact with someone who has COVID-19 or experiencing symptoms. STAY HOME. Do NOT bring your child(ren) to practice or games and should self-quarantine for 14 days.
By checking the Read and Understood checkbox for this agreement, I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at the event (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Lowen83 FC, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Club program.