Waiver & Liability Form - Athlete Cricket Tournament

Please complete all the required fields and sign the document below. If there are any questions or concerns, please contact AKYSB Central at [email protected]

I, (enter name)
in exchange for being given the opportunity to participate in
Herby give consent and permission for myself to attend and participate in the Activity on the following date(s)
I, on behalf of myself and my heirs, successors, assigns, and any other persons or entity claiming through or under any of them, agree to RELEASE, INDEMNIFY, and HOLD HARMLESS His Highness Prince Aga Khan Shia Imami Ismaili Council for the United States of America (the “Council”), its regional/local councils, boards, portfolios, members, staff, volunteers, and agents, including the organizers, counselors and staff associated with the Activity (collectively, the “Indemnitees”) from and against any and all losses, claims, damages, causes of action, liabilities, costs, and expenses which may be asserted against the Indemnitees, if any, of every nature whatsoever, known or unknown, which arise out of or are connected with

I, on behalf of myself and my heirs, successors, assigns, and any other persons or entity claiming through or under any of them, agree to RELEASE, INDEMNIFY, and HOLD HARMLESS His Highness Prince Aga Khan Shia Imami Ismaili Council for the United States of America (the “Council”), its regional/local councils, boards, portfolios, members, staff, volunteers, and agents, including the organizers, counselors and staff associated with the Activity (collectively, the “Indemnitees”) from and against any and all losses, claims, damages, causes of action, liabilities, costs, and expenses which may be asserted against the Indemnitees, if any, of every nature whatsoever, known or unknown, which arise out of or are connected with Any damages to person or property as a result of the Participant’s participation or any other person's participation in the Activity; Any injury or death, including that arising, in part or whole, from the sole or contributory negligence of the Indemnitees, occurring during or related to the Activity and/or any travel which participation in the Activity may involve; and Any policies, procedures, conduct, or negligent act or omission of the Indemnitees.
I/We hereby consent to any medical or surgical treatment which the Participant may need and which arises in connection with the Activity; provided, however, nothing contained herein shall be deemed an obligation to provide any such medical or surgical treatment. I/we understand that the Council and Indemnitees do not carry healthcare insurance that covers the Participant and therefore, I/we are solely responsible for the cost of all medical and surgical treatment. The parties agree that any controversy or claim arising out of or relating to the Activity or this Consent & Release Form shall first be submitted for mediation before His Highness Prince Aga Khan Shia Imami Ismaili National Conciliation and Arbitration Board for the United States of America.
I/WE HAVE READ AND VOLUNTARILY SIGN THIS CONSENT & RELEASE FORM AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
Print Name (Athlete):
Email Address:
Today's Date: Today's Date: / MM / DD YYYY
Code Number (Should have received it in the email)
Must be 8 digits. Currently Entered: 0 digits.
Please sign to Complete waiver form

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.