Youth Programming and Events Liability Release Form "*" indicates required fields Parental/Legal Guardian InformationLegal Guardian First Name*Legal Guardian Last Name*Relationship to Player*Please select an answerMotherFatherSiblingFriendFamily RelativeOtherLegal 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. What is your preferred method of communication?* Email Phone Call Text Social Media Participant InformationHow Many Participants Are Interested?* 1 2 3 4 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* MM slash DD slash YYYY 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 No Prefer Not to Answer Participant 2 Date of Birth* MM slash DD slash YYYY 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 No Prefer Not to Answer Participant 3 Date of Birth* MM slash DD slash YYYY 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 No Prefer Not to Answer Participant 4 Date of Birth* MM slash DD slash YYYY 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 No Prefer Not to Answer Emergency ContactEmergency 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)Please select an answerMotherFatherSiblingFriendFamily RelativeOtherWhich 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?*I'm an existing member of Minnesota DodgeballGoogle/Search EngineFacebookInstagramRedditTikTokMeetupWebsiteWord of Mouth/Through a FriendFestival/EventBrochure/FlyerOtherIf you're new to Minnesota Dodgeball, how did you find us? Policy AgreementsRelease of Liability & Photo Release*ASSUMPTION OF RISK In consideration of being allowed to participate in any activities organized by Minnesota Dodgeball LLC (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 read, understood, and agree to the terms of this agreement.Code of Conduct and Policies Agreement*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 and understood the code of conduct and anti-harassment policy and agree to abide by it.Diversity, Equity & Inclusion Statement*As an organization founded by an openly queer immigrant, we deeply value the creation of an inclusive environment where individuals can freely embrace their true selves. At Minnesota Dodgeball, we are firmly dedicated to amplifying the voices of those who face persecution and injustice. Our unwavering commitment lies in cultivating a safe, enjoyable, and inclusive experience for everyone, irrespective of their gender identity, sexual orientation, race, disability, age, and other protected classes. Discrimination in the form of bigotry, racism, sexism, transphobia, homophobia, and other forms of prejudice behavior are strictly prohibited and will result in immediate dismissal from all Minnesota Dodgeball events. If you believe that you cannot hold yourself to these standards, we ask that you look at other opportunities to play dodgeball. I confirm that I have read and understood our DEI policy and commit to adhering to it. I recognize that any violation of this policy may result in suspension or a ban from future events.Queer Friendly Space*At Minnesota Dodgeball, our leagues are more than just games—they are a sanctuary for everyone who believes in equality, inclusion, and respect. By joining us, you are committing to actively support, protect, and uplift the voices and experiences of all members of our community, including the queer community. We ask that every participant embraces the responsibility to foster an environment where all individuals feel safe, respected, and empowered to be their authentic selves without fear. Let’s work together to create a community where diversity is celebrated, and everyone can thrive. I recognize that this space includes members of the queer community and pledge to uplift their voices while fostering a safe and inclusive environment for everyone.Guest and Minor Policies*Minnesota Dodgeball is not responsible for any guests or minors brought into our facilities or events. By bringing guests or minors, you acknowledge that you are solely responsible for their actions, safety, and conduct while on the premises or participating in any Minnesota Dodgeball activities. Minnesota Dodgeball will not be held liable for any injury, harm, or damages that may occur to guests or minors during their participation in or presence at our events or facilities. I understand and accept full responsibility for the behavior, safety, and well-being of any guests or minors I bring to Minnesota Dodgeball events or activities.Concussion PolicyRisk 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 headNausea or vomitingBalance problems or dizzinessDouble or blurry visionSensitivity to light or noiseFeeling sluggish, hazy, foggy, or groggyDifficulty concentrating or rememberingConfusionJust 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: CDC Heads UpConcussion Legacy FoundationNHS: Concussion - Symptoms and TreatmentBy 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 and your participant's safety and well-being while attending and participating in this event. We reserve the right to refuse service to any individual at our discretion.
