2025 Waiver Please fill out all information below for the Regina Riot 2025 Season.Player Name (Format: First Middle Last) EX: Sally Anne Smith(Required)Date of Birth (Format: DD/MM/YY)(Required)Email(Required) Phone number (Format: XXX-XXX-XXXX)(Required)Home address(Required)Emergency Contact(Required)Emergency Contact relationship(Required)Emergency Contact Phone Number (Format: XXX-XXX-XXXX)(Required)Health Card Number(Required)Family Physician(Required)Physician address or office(Required)Please list any conditions or allergies that you have that we should be awareof (asthma, diabetes, etc.)(Required)Self-IdentificationThe following questions are not mandatory to answer. The data is used for multiple things such as: grant opportunities and to better understand our athlete base. More than one answer can be chosen for each question. What is your gender identity? Woman Man Non-binary Transgender Prefer not to answer What is your sexual orientation? Asexual Bisexual/pansexual/demisexual Heterosexual/straight Lesbian/gay Queer Prefer not to answer What racial identity best describes you? Arab/middle eastern/west eastern Black Indigenous Latino/latina/latinx Native Hawaiian/Pacific Islander South Asian/Indo-carribean White Prefer not to answer Do you identify as a person with a disability? Yes No Prefer not to answer Regina Riot Terms and Liability Waiver 2025RELEASE FROM LIABILITY I agree to assume all risks and hazards incidental to participation in tackle football. I do hereby waive, release, absolve, indemnify, and agree to hold harmless, Regina Riot Football Inc. the officers, directors, coaches, sponsors, volunteers, individual chapters, participants, and persons transporting myself to and from any team activities, for any claim arising out of an injury, whether the result of negligence or any other cause.(Required) I agree.MEDICAL RELEASE I hereby grant permission to Regina Riot Football Inc. to administer first aid, secure proper treatment, and/or hospitalize myself in case of emergency, provided I am unable to communicate with them, and according to their best judgement.(Required) I agree.PHOTOGRAPH RELEASE I hereby grant permission to Regina Riot Football Inc. to take photographs or video of myself at Team events for promotional, website and social media use and to tag me in posts on social media. I agree.Medical Certificate & Waiver I am satisfied that I/my daughter is in good health to take part in strenuous activities. She gives/I give my permission to participate in those approved physical activities leading up to and including the Regina Riot Football practices and camps, and I absolve the Regina Riot Football Club and/or any of its staff,directors, executive, associations, members, volunteers or sponsors including the WWCFL & Football Saskatchewan from any and all liability whatsoever in relation to me/my daughter being examined by a physician for all football activities. I also agree with the need to be/have my daughter examined by a physician following an illness or injury to re-establish a bill of good health, and that this or any other medical examination is my sole responsibility.(Required) I agree.Physical Examination Certificate I certify that I have undergone a physical examination conducted by registered physical physician, in this current calendar year. The physician certifies that they have found me in good health and without any objective signs of any physical disability and may participate in the strenuous activities associated with the Regina Riot Football club practices/training camps and the WWCFL season.(Required) I agree.WWCFL Waiver I have read, understand, and signed the WWCFL Informed Consent and Assumption of Risk Agreement.(Required) I agree.Player Agreement I have read and understand the Player Agreement document provided. I acknowledge and agree to the values and expectations the Regina Riot have of me.(Required) I agree.DECLARATION I hereby acknowledge with indicating "I agree" below that I have read, understood, accept and agree to all terms and conditions of the Regina Riot. Acknowledging that I will not hold the Regina Riot football team, members, coaches or staff responsible for injuries of damages that may occur.(Required) I agree. Δ
