MSFHCA

Massachusetts State Field Hockey Coaches Association

BEST OF 60 ALL*STAR GAME 2006

INFORMED CONSENT/RELEASE

NAME:                                                   AGE:                

HIGH SCHOOL:                                   

ADDRESS:                                                        

PHONE:                                                          

CITY:                                                                  STATE: MA

ZIP:                                             

INSURANCE COMPANY:                                                          

POLICY #:                               

IN CASE OF EMERGENCY:

NAME:                                                        

PHONE:                      

INFORMED CONSENT/RELEASE

Field Hockey is a game played by two teams of not more than 11 players each on a rectangular field. Each player carries a curved stick for the purpose of propelling a ball into the goal cage. The goal is 12 feet wide and 7 feet high. The ball is a hard, solid sphere made of plastic. Team members dress in uniform shirts and all field players wear moth protectors and shin guards. The goalkeeper wears a full-face cage or mask, helmet, chest protector, leg pads, kickers, gloves, and a neck protector.

            All rules of the National Federation shall be followed except as modified by the MIAA. Officials shall be rated Field Hockey Officials and their decision on game play is final.

All participants in the MSFHCA Senior All-Star Game are expected to have knowledge of the rules of play of Field Hockey as well as the basic skills needed to compete. The execution of skills specific to Field Hockey, as well as, those skills of any active field game are required.

Due to the nature of the game of Field Hockey, there is occasional contact between the ball or stick and a part of the body. There is also the unintentional contact between players as in any field game. As with any athletic endeavor, there is always the risk of physical injury. MSFHCA will provide professionally officiated games on a playable surface. An Athletic Trainer will be available on site for emergency medical attention.

            In consideration for acceptance into participation in the MSFHCA Senior All- tar Game the undersigned parent or guardian and player releases MSFHCA (its officers and members), MSSFHA (its officers and members) and Bentley College (its officers, agents, and their spectators) from any and all claims for any personal injuries, injurious results, damages, or losses sustained by the participant and the undersigned indemnifies MSFHCA, MSSFHA, and Bentley College (its officers, members, agents, and spectators) against all claims for such loss, damage or injury sustained by the player or by any person whomsoever. It is further agreed that the player must be covered by medical insurance and that the participant’s applicable coverage is listed above. These informed consent, waiver, release, and hold harmless agreement shall also apply to pre and post competition activities.

            I have read the above explanation of the game of Field Hockey and understand the nature of the game and the risks involved in participating in the Senior All-Star Game. I accept these risks and would like to participate in the MSFHCA Senior All-Star Game.

SIGNATURE OF PARENT/GUARDIAN:                                                                    

DATE:          

SIGNATURE OF PLAYER:                                                              DATE: