Waiver Form for Summer League

City of Dover
Parks & Recreation Department

Waiver – Release Statement        High School Field Hockey League

PLEASE PRINT AND FILL OUT COMPLETELY        CITY OF DOVER RESIDENT – YES     NO

Parent/Guardian First Name:                            Last Name:


Address:                                     City:             State:        Zip:

Phone: (home)                    (work)                        (other)

Players e mail address:

Parents e mail address:

Participant/Player Information

1st Player’s First and Last Name                                    Age        DOB

2nd Player’s First and Last Name                                    Age        DOB

RELEASE STATEMENT: I understand that the City of Dover provides no medical coverage for participants unless specified and that all bills which may be incurred as a result of an activity-related injury are my responsibility. I hold harmless the city of Dover and all other parties involved in the condition of these activities. I agree that any photographs taken during the events shall be and remain the property of the City of Dover, and that the City of Dover shall have the right to use such photographs and/or films whenever so desired free of any claims on my behalf.

Parent/Guardian Signature:                                Date: