Terms of Service

Voluntary Activities
Waiver of Liability, Assumption of Risk & Indemnity
Agreement

Waiver: In consideration of being permitted to participate in any way in
Activity: Zico 10 Camp USA
Locations: Keio Academy of New York, 3 College Road, Purchase, NY 10577
CCPRO Soccer, 109 Saint Charles st, Newark, NJ 07105
Date(s): Tuesday June 25, 2024
Wednesday June 26, 2024
Time(s): 09:00 am – 02:00 pm
05:30 pm – 09:30 pm

Thereinafter called “The Activity”, I, for myself, my heirs, personal representative or assigns, do hereby
release, waive, discharge, and covenant not to sue the ZICO 10 CAMP, KEIO ACADEMY OF NEW
YORK, CANVAS CREATIVE GROUP LLC and CASCARDO PRO SOCCER CORPORATION, its officers,
employees, and agents from liability from any and all claims including the negligence of the ZICO 10
CAMP, KEIO ACADEMY OF NEW YORK, CANVAS CREATIVE GROUP LLC and CASCARDO PRO
SOCCER CORPORATION , its officers, employees and agents, resulting in personal injury, accidents, or
illnesses (including death) and property loss arising from, but not limited to, participation in the Activity.

Assumption of Risks: Participation in The Activity carries with it certain inherent risks that cannot be
eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains; 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions; 3) catastrophic injuries including paralysis and death.

I have read the previous paragraphs and I know, understand, and appreciate these and other risks
that are inherent in The Activity. I hereby assert that my participation is voluntary and that I
knowingly assume all such risks.

Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD the ZICO 10 CAMP, KEIO
ACADEMY OF NEW YORK, CANVAS CREATIVE GROUP LLC and CASCARDO PRO SOCCER
CORPORATION HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in The Activity and to reimburse them for any such expenses incurred.

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks
agreement is intended to be as broad and inclusive as is permitted by the law of the State of New York and the State of New Jersey and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Photographic Release: I do hereby grant and convey unto the ZICO 10 CAMP, KEIO ACADEMY OF NEW
YORK, CANVAS CREATIVE GROUP LLC and CASCARDO PRO SOCCER CORPORATION all right, title
and interest in any and all photographic images and video or audio recordings made by the ZICO 10 CAMP, KEIO ACADEMY OF NEW YORK, CANVAS CREATIVE GROUP LLC and CASCARDO PRO SOCCER
CORPORATION during my participation in The Activity, including, but not limited to, any royalties, proceeds or other benefits derived from such photographs of recordings.

Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity
agreement, fully understand its terms, and understand that I am giving up substantial rights, including
my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my
signature to be a complete and unconditional release of all liability to the greatest extent allowed by
law.

MEDICAL AUTHORIZATION – MINOR
ALL INFORMATION REQUESTED BELOW MUST BE PROVIDED

IF ALL INFORMATION IS NOT PROVIDED, THE FORM WILL BE RETURNED TO YOU;
YOU WILL NOT BE ALLOWED TO PARTICIPATE IN THIS ACTIVITY UNTIL THE COMPLETED FORM IS RETURNED

I understand that I hold the ZICO 10 CAMP, KEIO ACADEMY OF NEW YORK, CANVAS CREATIVE
GROUP LLC and CASCARDO PRO SOCCER CORPORATION, its officers, agents, employees and
volunteers harmless from any and all liability or claims, which may arise out of or in connection with my child’s voluntary participation in the following activity.

Activity: Zico 10 Camp USA
Locations: Keio Academy of New York, 3 College Road, Purchase, NY 10577
CCPRO Soccer, 109 Saint Charles st, Newark, NJ 07105
Date(s): Tuesday June 23, 2024
Wednesday June 25, 2024
Time(s): 09:00 am – 02:00 pm
05:30 pm – 09:30 pm

In the event of illness or injury, I do hereby consent to whatever x-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care are considered necessary in the best judgment of the attending physician, surgeon, or dentist and performed by or under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services. It is understood that the resulting expenses will be the responsibility of the participant.

I fully understand that participants are to abide by all rules and regulations governing conduct during the activity. Any violation of these rules and regulations may result in that individual being sent home at the expense of his/her parent/guardian.

Parent/Guardian of Minor:

Check here if there are no special medical needs that the staff should be aware of and no medications are required for this activity.
If your child will be required to take medication while participating in this activity, all medications must be informed;
All drugs, excepting those which must be kept on the student’s person for emergency use, must be kept and distributed by the staff; If any medications are to be taken by the student, list the name and purpose of them and or If your child has any special medical needs please send a email to: info@zico10camp.com