IN CONSIDERATION of the risk of injury that exist while participating in Kiwanis Frankfort Soccer Camp and Clinic (hereafter The “Activity”); and

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IN CONSIDERATION of my desire to participate in said Activity and being given the right to participate

I HEREBY, for myself, my heirs, executors, assigns, or personal representative (hereafter collectively “Releasor”, “I” or “me”,

Which terms shall also include Releasor's, parents or guardian if releasor is under 18 years of age) knowingly and voluntarily

Enter into WAIVER AND RELEASE OF LIABILITY  and hereby wave any and all rights, claims or causes of actions of any kind of injuries arising out my participation in the Activity ; and

I HEREBY release and forever discharge Kiwanis Soccer Camp and Clinic, located in Frankfort Kentucky and affiliates, managers, coaches and volunteers, heirs, representatives' predecessors, successors and assigns ( collectively Releases),

From any physical or psychological injury that may suffer as direct result of my participation in the aforementioned Activity.

Name of the child:     ………………………………………………………………

Age :               ……………………

Gender:         ……………………

Name and signature of parent and/or guardian

Print Name:   ..…………………………………………………………………………

Signature:      ………………………………………………………………………….