Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Preferred Junior Assistant Program(s) *

Kids Academy

Capitol Hill League

One Day Camp

Parent/Guardian’s Name *

First Name

Last Name

Parent/Guardian’s Phone *

(###)

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Waiver and Release of Liability *

I, as the legal Parent, Guardian of the child mentioned above, do hereby release, Denis Chekuristov, DC WAY LLC, its owners, employees, contractors, agents, officers, volunteers, and managers from any and all claims arising from personal injury no matter how caused, which my child may incur or suffer during my child's participation in DC Way soccer programs. I hereby waive any claims, suits, actions, or causes which I or my child may or hereafter have against Denis Chekuristov, DC WAY LLC, its owners, employees, contractors, agents, officers, volunteers, and managers for personal injury, no matter how caused which I or my child may have incurred, may incur or suffer during my child's participation in soccer drills, scrimmages or sessions. I further agree to indemnify and hold forever harmless, Denis Chekuristov, DC WAY LLC, its owners, employees, contractors, agents, officers, volunteers, managers, and successors against all losses, including counsel fees and court costs, from any and all claims made against it by any party as a result of my or my child's actions, negligent or intentional, which may result in the injury or loss to another participant or spectator. In addition, in the event that I cannot be reached, I hereby give permission to the Camp Director to obtain appropriate medical treatment for my child. I, the parent (guardian) of the child mentioned above, give permission for the named camper to receive emergency medical or surgical treatment and hospitalization if necessary. I understand that every attempt will be made to contact me, or the emergency contact named above, before taking this action. I will be financially responsible for any medical attention needed during camp or resulting from an injury received at camp. My medical insurance shall be the insurance coverage for any medical treatment. I further agree that my child can receive over-the-counter remedies. (Tylenol, Sudafed, etc.) DC WAY LLC is not responsible for providing insurance coverage for coaches under the age of 18. I HAVE READ THIS HEALTH FORM AND RELATED CERTIFICATIONS, THE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND THEIR TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGNING IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I agree

Soccer Field Release *

I give my child permission to participate in soccer programs as a Junior Assistant.

I accept

Junior Assistant Commitment *

I agree to serve, if accepted, as a Junior Assistant at a DC Way program.

I agree

Acceptance *

I understand the completion of the application for the Junior Assistant does NOT automatically assure me a position in this program for 2024.

I agree

Walking Waiver *

I, as the legal Parent, Guardian of the child mentioned above, hereby grant permission for my child to participate in the DC Way program. I understand that it may involve, but is not limited to the following activities: walking to and from parks and other facilities, indoor/outdoor games and activities, and other. In consideration of my child's participation in the program, I hereby waive, release, and discharge Denis Chekuristov, DC WAY LLC, its owners, employees, contractors, agents, officers, volunteers, and managers from any and all claims, liabilities, or demands for personal injury, property damage, or any other loss that my child may incur during the day. I have carefully read and fully understand the contents of this waiver and release and agree to its terms voluntarily.

I agree

Photo Waiver *

I grant DC WAY LLC the right to take photographs and videos of me and my family in connection with the above-identified event. I authorize DC WAY LLC and its assigns and transferees to copyright, use, and publish the same in print and/or electronically. I agree that DC WAY may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content. I have read and understood the above release.

I agree