Festival Youth Forms | Minnesota Dodgeball

Event/Festival Youth Form

"*" indicates required fields

Are you taking part in the dodgeball field today?*

Yes

Do you have a youth player participating onto the field to play dodgeball?

Parental/Legal Guardian Information

Legal Guardian First Name*

Legal Guardian Last Name*

Relationship to Player*

Legal Guardian Phone Number*

In case of an emergency or the need to share important information with you, we require your phone number. It will only be used for program-related matters or registration issues. Your information will remain private and will not be shared without your prior consent.

Legal Guardian Email*

This email will be used for important updates regarding your RSVP and future information about Minnesota Dodgeball.

Which of our dodgeball programs are you most interested in being a part of or learn more about?*

Youth Open Dodgeball Leagues - Leagues open to all youth ages 7 to 18, regardless of identity.

Youth Lavender Dodgeball Leagues - A welcoming and inclusive league for LGBTQIA+ youth players.

Youth Tournaments - Annual tournaments held across the state.

Youth Performance Clinics - Personalized performance clinics for youth

Youth Open Gyms - Casual pick-up games with low stakes

How Did You Find Us?*

If you're new to Minnesota Dodgeball, how did you find us?

Participant Information

How Many Participants Are Interested?*

Please note that there is an additional cost for each participant. If more than 4 players, please talk to staff.

Participant 1 First Name*

Participant 1 Last Name*

Participant 2 First Name*

Participant 2 Last Name*

Participant 3 First Name*

Participant 3 Last Name*

Participant 4 First Name*

Participant 4 Last Name*

Participant 1 Date of Birth*

Participants must be between the ages of 7 and 18.

Participant 1 Age*

Does Participant 1 identify as part of the Women, Trans, and Nonbinary community?*

Yes

Prefer Not to Answer

Participant 2 Date of Birth*

Participants must be between the ages of 7 and 18.

Participant 2 Age*

Does Participant 2 identify as part of the Women, Trans, and Nonbinary community?*

Yes

Prefer Not to Answer

Participant 3 Date of Birth*

Participants must be between the ages of 7 and 18.

Participant 3 Age*

Does Participant 3 identify as part of the Women, Trans, and Nonbinary community?*

Yes

Prefer Not to Answer

Participant 4 Date of Birth*

Participants must be between the ages of 7 and 18.

Participant 4 Age*

Does Participant 4 identify as part of the Women, Trans, and Nonbinary community?*

Yes

Prefer Not to Answer

Emergency Contact

Emergency Contact First Name (if different from Legal Guardian above)

Emergency Contact Last Name (if different from Legal Guardian above)

Emergency Contact Number (if different from Legal Guardian above)

Relationship to Participant (if different from Legal Guardian above)

Policy Agreements

Release of Liability & Photo Release*

ASSUMPTION OF RISK
In consideration of being allowed to participate in any activities organized by Minnesota Dodgeball LLC, event organizers, (collectively referred to as "the Organizers"), such as programs, leagues, pickup/open gyms, tournaments, related events, the undersigned acknowledges, appreciates, and agrees that:

1. The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) from the activities involved in this program are significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and,

3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the Organizers, their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

PHOTO RELEASE
I, hereby grant permission to the Organizers to use photographs and/or videos of myself taken during my participation in the Organizers' events, including but not limited to dodgeball games, sport practices, and related activities. This permission includes the right to publish, reproduce, distribute, and/or display the photographs and/or videos in any media format, including but not limited to online platforms, social media, print materials, and promotional materials.

I understand and agree that the photographs and/or videos may be used for various purposes, including but not limited to advertising, publicity, marketing, and educational materials related to the Organizers and its activities.

I further release the Organizers, its representatives, agents, employees, and any third parties acting under its authority, from any claims, demands, or liabilities arising out of or in connection with the use of the photographs and/or videos, including but not limited to any claims for compensation or violation of rights or privacy.

By putting down your email, you acknowledge and consent to receiving emails from the Organizers. These emails may include updates, announcements, event invitations, and other relevant information pertaining to the league. However, we respect your privacy, and you will always have the option to unsubscribe from these emails by following the instructions provided in the email or contacting us directly.

I acknowledge that I will not be entitled to any compensation or consideration for the use of the photographs and/or videos. I certify that I am at least 18 years of age, or if I am under 18 years of age, I have obtained the consent of my parents or legal guardian to sign this release form.

I HAVE READ THIS RELEASE OF LIABILITY/ASSUMPTION OF RISK AGREEMENT & PHOTO RELEASE, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SUBMITTING THE FORM, AND AGREE TO IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

I confirm that I have diligently read and fully understood the code of conduct and policies manual established by Minnesota Dodgeball. I hereby pledge to adhere to this code during my participation in all events, including leagues, open gyms, and other organized gatherings. I understand that any failure to comply with the code may lead to my immediate dismissal from the event, and I acknowledge that no refunds will be provided in such circumstances. We encourage you to download this document for your records.

I confirm that I have read, understood, and agree to the terms of this agreement.

Event Release of Liability*

By playing Dodgeball at this event, I hereby accept any risks involved in participation, accept all liability, and will hold harmless all organizers or any damages to my property or injuries to my person. This release of liability includes, but is not limited to, damages or injuries incurred due to negligence, carelessness, or equipment failure.
I agree to abide by the precautions and safety instructions put into place by this event.

These risks include, but are not limited to:
• Slipping or falling that results in physical injury.
• Bumping into, colliding, or otherwise making contact with other people, barrier walls, the floor, observers, or other objects in a manner that results in physical injury.
• Being struck by flying or falling objects of any kind..
• Injuries including but not limited to: broken teeth, eye injury, bruising, sprains, internal injuries, joint dislocation, bone breakage, full or partial paralysis, or death.
• Playing in an outdoor setting: inclement weather, sunburn, heat stroke, or dehydration.
• Experiencing anxiety, exhaustion, or other emotional and physical responses to the activity.
I agree to mitigate the risk of damages or injury by following the safety rules as follows:
• Emptying my pockets of all items and carrying nothing upon my person.
• Wearing clothing appropriate for playing. If eyeglasses are worn, they must be properly secured.
• Knowing my physical abilities, balance, reaction time.
• Taking other common-sense precautions not necessarily enumerated in this waiver or by event staff or operators.

By signing below, I agree to waive liability for damages or injuries. Specifically, I will be liable for any and all medical costs, attorney fees, and other costs. I also assert that I am in sound physical condition for playing dodgeball, and am not under the influence of alcohol or drugs that could impair my ability to participate safely.

I fully understand and agree to the above terms.

Concussion Policy

Risk of Concussion*

Overview
Your safety is our top priority. Concussions are serious injuries that can occur in any sport or physical activity, including dodgeball. Understanding the risks and knowing how to respond can help prevent long-term health issues.

What is a Concussion
A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or body that causes the brain to move rapidly inside the skull. Even a "ding" or a bump on the head can be serious.

Symptoms of a Concussion

Headache or "pressure" in the head

Nausea or vomiting

Balance problems or dizziness

Double or blurry vision

Sensitivity to light or noise

Feeling sluggish, hazy, foggy, or groggy

Difficulty concentrating or remembering

Confusion

Just not "feeling right" or "feeling down"

Steps we take if a Concussion is Suspected

Remove the Player from Play: If a player is suspected of having a concussion, they must be immediately removed from the activity.

Seek Medical Attention: A healthcare professional experienced in concussions should evaluate the player as soon as possible.

Inform the League Manager: Notify the league manager or event organizer about the suspected concussion.

Follow the Medical Advice: The player should follow the healthcare professional’s advice and instructions for a gradual return to activity.

Rest and Recovery: Ensure the player gets plenty of rest and avoids activities that could risk another concussion.

Return to Play Protocol
A player who has been diagnosed with a concussion can only return to play after receiving written clearance from a healthcare professional. The return to play will only be allowed if the player remains symptom-free.

Educational Resources

To help you understand the risks associated with concussions and what to do if one occurs, please review the following resources:

By registering, you acknowledge that you have read and understand the concussion policy, agree to adhere to its guidelines, and will not hold Minnesota Dodgeball liable for any injuries, including concussions, that may occur during participation in this activity.

I acknowledge the concussion policy and have reviewed the resources. I understand the risks involved in participating in this physical activity.

Signature*

Please read and sign to acknowledge that you understand and agree to all the policies outlined above. By signing, you confirm that the information provided is accurate, and you agree not to hold Minnesota Dodgeball LLC or its organizers, partners, and affiliates liable for any injuries or incidents that may occur during your participation in this event. You also waive the right to pursue legal action against Minnesota Dodgeball LLC and its organizers, partners, and affiliates. Your signature indicates that you accept full responsibility for your own safety and well-being while attending and participating in this event. We reserve the right to refuse service to any individual at our discretion.