Iconic Soccer Academy U18 – Iconic Sports Lab | A 501c3 non-profit based in NYC that fuels societal progress via youth leadership and sports.

Flushing Meadows Corona Park 2024 Season

Player Information*

First Name Last Name

Email Address*

Date of Birth*

Gender*

Male
Female

Address*

Street Address City State ZIP Code

Age Divisions*

U-18

T-Shirt Size*

Adult Small (S)
Adult Medium (M)
Adult Large (L)
Adult X-Large (XL)

Parent/Guardian Information*

First Name Last Name

Parent/Guardian Phone Number*

Parent/Guardian Email Address*

Emergency Contact Number*

Does the Player have a chronic medical condition such as asthma, diabetes, seizure disorder, severe allergies or mental health condition?*

Yes
No

If Yes, please specify

Waiver*

Iconic32 Sports Lab, Inc. DBA ICONIC SPORTS LAB PROGRAM PARTICIPATION

APPEARANCE RELEASE AND WAIVER OF LIABILITY

I, ___________________________, sign this release and waiver of liability (this “Release and Waiver”) in consideration of being allowed to participate in the Iconic Sports Lab youth soccer programs in New York City, NY (the “Programs”). I hereby fully defend, indemnify and hold harmless and voluntarily release, and discharge Iconic32 Sports Lab, Inc (“Iconic Sports Lab”), and each of its officers, directors, representatives, employees, sub-contractors, sponsors, parent companies, subsidiaries, affiliates, successors and assigns (collectively, the “Released Persons”) from any and all claims, demands, damages, costs, liabilities and expenses (including without limitation reasonable legal fees and expenses) which I may have, whether known or unknown, asserted or not asserted, arising out of my participation in the Programs, whether caused by negligence or otherwise, including without limitation any and all claims of co-participants, rescuers and others arising from my conduct in the course of my participation in the Events/Programs.

I acknowledge that the program may be photographed, filmed or videotaped, and in connection therewith, I hereby grant my irrevocable permission to the Released Persons to utilize the results and proceeds thereof (collectively, the “Photos and Production”), as well as my name, image, face, likeness, biographical information, tattoos, appearance and/or voice for any purpose whatsoever, including but not limited to, in programming, advertising and/or promotion of the Event and/or any of the Released Persons in any and all media, whether now known or hereinafter invented, throughout the world in perpetuity, without any further compensation to me. The Photos and Production shall be deemed “works made for hire” for Iconic Sports Lab within the meaning of the United States copyright law, and accordingly, as between the parties hereto, Iconic Sports Lab will be deemed the exclusive owner thereof for all purposes. If all or any part of the Photos and Production are not deemed works-made-for-hire, then I hereby assign to Iconic Sports Lab all rights in and to such Photos and Production. Nothing herein shall be deemed to require any such photography or videotaping, nor shall the use, distribution, publishing or exhibition of any of the Photos and Production be required.

No Photos and Production need be submitted to me for approval. I fully release and discharge the Released Persons from any and all claims, demands, damages, costs, liabilities, and/or expenses arising from use of the Photos and Production, including without limitation claims for misrepresentation of me, my character, or my person by any means including editing, juxtaposition with other materials, blurring, distortion, optical illusion or faulty reproduction or transmission. If I should receive any print, negative or other material containing any depiction of the Event, I will not authorize its use by anyone else.

I understand that none of the Released Persons are assuming any responsibility for, or obligation to provide, financial assistance or other assistance, including but not limited to medical, health, or disability insurance, in the event of injury, illness, death, or property damage. I understand that none of the Released Persons are carrying or maintaining any health, medical, or disability insurance coverage for any participants with respect to the Event.

I understand and agree that I am not only giving up my right to sue the Released Persons but also any rights my heirs, assigns, or beneficiaries may have to sue the Released Persons resulting from my injury, property damage, or death. I further represent that I have the authority to do so and that my heirs, assigns, or beneficiaries will be stopped from claiming otherwise because of my representations to the Released Persons. I further understand, acknowledge and accept that participation in the Event involves certain inherent risks, whether foreseen or unforeseen, including, but not limited to, property damage and serious bodily injury (including permanent disability and death), and agree that I am voluntarily participating in the Event with full knowledge of the risks involved and accept all risks of participation. I declare that I am physically fit, not under the influence of alcohol or non-prescription drugs, and have the requisite skill level to participate in the Event. I authorize Iconic Sports Lab and/or a party designated by Iconic Sports Lab to provide and/or procure medical treatment or assistance to me at my sole cost should the need arise in Iconic Sports Lab’s reasonable discretion.

I understand that an inherent danger and risk of exposure to novel coronavirus SARS-CoV-2 and any resulting disease (together with any mutation, adaptation or variation thereof, “COVID-19”) exists in any public place where people are present. I understand that COVID-19 is an extremely contagious disease that can lead to severe illness and death, that no precautions can eliminate the risk of exposure to COVID-19, and that the risk of exposure applies to everyone. I understand that, according to the Centers for Disease Control and Prevention (CDC), senior citizens (people 65 and older) and people with underlying medical conditions are especially vulnerable, including people with chronic lung disease or moderate to severe asthma, serious heart conditions, compromised immune systems, severe obesity, diabetes, chronic kidney disease undergoing dialysis, and liver disease. I also understand that contracting COVID-19 can result in the further transmission of COVID-19 to my spouse, family members and other contacts. By entering, remaining, and/or participating in the Event, I knowingly and voluntarily assume and accept personal responsibility for all risks in any way related to exposure to COVID-19, including illness, injury, or death, and including without limitation, all risks based on the sole, joint, active or passive negligence of any of the Released Parties. On my own behalf, and on behalf of my heirs, executors, administrators and next of kin, I hereby release, covenant not to sue, and forever discharge the Released Parties of and from all liabilities, claims, causes of action, damages, costs or expenses of every kind (“Claims”) arising out of or in any way connected to exposure to COVID-19 during my presence at the Event, including any Claims related, in whole or in part, to my own negligence, action or inaction, or the negligence, action or inaction of any Released Party or any other person or entity, whether foreseeable or unforeseeable. I further agree to indemnify and hold each of the Released Parties harmless from and against any and all such Claims including, but not limited to, all attorneys' fees and disbursements up through and including any appeal. I expressly agree that the release and indemnity provided for in this Release and Waiver shall cover all physical and emotional injuries and/or damages, including without limitation all illness and bodily injury (including death), whether suffered by me or anyone else before, during or after my visit and/or participation.

I understand, acknowledge and accept that this Release and Waiver is intended to be as broad and inclusive as permitted by the laws of the State of New York and agree that if any portion of this Release and Waiver is invalid, the remainder will continue in full legal force and effect. I understand the terms herein are contractual and not a mere recital, and that I have signed this Release and Waiver of my own free act and with the knowledge that I hereby agree to waive my legal rights. This Release and Waiver may not be modified or changed in any way by representations or statements by either party and hereby supersedes any and all previous oral or written promises or agreements. I further agree that any legal proceedings related to this Release and Waiver shall exclusively take place in New York, New York.

If Participant is under 18 years old, this form must be signed by the Participant's parent or Legal Guardian.

I am the parent/legal guardian of the above-mentioned minor. I consent to the foregoing on behalf of such minor, and personally join in the warranties, representations and other provisions set forth above. I agree to indemnify and hold harmless the Released Persons with respect to any claims which the minor may make, or which may be made on behalf of the minor, as a result of the exercise of its rights hereunder.

that participation in the Iconic32 Sports Lab, Inc. Iconic Classic (“Program”) involves certain inherent risks of injury, despite all safety precautions taken by the Iconic32 Sports Lab, Inc. and operators. Therefore, I will assume all risks, injury, sickness or illness, including communicable diseases, that may occur during the participation in any activities or use of facilities associated with the Program. In the event that I need medical treatment due to accident or injury or natural causes while participating in the Program, I authorize the local staff/operators to take whatever action is necessary to care for me. I hereby give permission for the local staff and operators to use their best judgment in arranging for my emergency medical treatment.

By signing this form, I acknowledge that I am aware of the potential risks of participation in any activities or use of facilities associated with the Program, and in no way hold the Iconic Sports Lab, its respective parent, its subsidiaries or affiliates, or their respective management, agents, employees, directors, officers, sponsoring agencies, partners, volunteers or the facility or its operators, coaches, officials, or advertisers, (Individually and Collectively, the “Released Parties”), liable for any injury that I may sustain. I, FOR MYSELF, DO RELEASE, ABSOLVE, INDEMNIFY, AND HOLD THE RELEASED PARTIES HARMLESS AGAINST ANY CLAIMS OF INJURY OR DEATH IN CONNECTION WITH ANY AND ALL OF THE ACTIVITIES MENTIONED.

Finally, I hereby grant a license to Iconic32 Sports Lab, Inc. and Released Parties, including any
advertising agencies, to use and to license others to use my name, recorded voice, image, picture or
likeness in any live or recorded audio, video or photographic display or other transmission for purposes of promotion and publicity in connection with the Program and any future Iconic Sports Lab events or programs and hereby waive any rights of compensation or ownership thereto.

I HAVE READ, AND I UNDERSTAND, AND I VOLUNTARILY SIGN THIS MEDICAL
RELEASE/WAIVER/INDEMNITY AGREEMENT AND MODEL RELEASE AND AUTHORIZATION TO
VIDEO/PHOTOGRAPH.

Yes, I agree to the waiver of liability.

I acknowledge that the information presented on this registration form is complete, correct, and truthful, and I am willing to abide by the rules and regulations set forth by Iconic Sports Lab.

Signature of Parent (if under 18 years old)*

Date*

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.