La Galaxy Game Waiver

FIELD TRIP TO THE LA GALAXY SOCCER GAME WHERE: THE HOME DEPOT CENTER 18400 AVALON BOULEVARD CARSON, CA 90746 310-630-2000 WHEN: JUNE 13th, 2009 TIME: The bus will depart from Palms Middle School along Palms Blvd. at 6 PM. The Game kicks off at 7:30 PM. The buses will return to Palms Middle School along Palms Blvd. at approximately 10 PM. All LA SCORES coaches will remain with the students until they have been picked up by parents. DETAILS: Students will travel by school bus transportation provided by Bernie Bus Lines to watch the game with their teammates and coaches. This is a wonderful opportunity for these kids and is well-deserved for all they have accomplished during the fall season. ADULT CHAPERONES:LA SCORES COACHES AND STAFF PARENT VOLUNTEERS LA SCORES STAFF:

David Joseph, Executive Director (310) 351-1815 Amy Fleischauer, Program Director (310) 883-8710

Please Complete the Following: I hereby grant permission for my child________________________________________________ to participate in the field trip to watch the LA Galaxy Soccer Game. I understand that the trip will be going to The Home Depot Center, and that LA SCORES will be transporting my child. Parent/Guardian Contact 1________________________________________________\ Phone Number___________________________________ Parent Guardian Contact 2________________________________________________ Phone Number___________________________________

3685 Motor Ave., Suite 110● Los Angeles, CA 90064 Tel: 310-204-6455 ● Fax: 310-204-6455

PERMISSION RELEASE As the parent or legal guardian of this child___________________________________, I give permis­ sion for him/her to be transported to and participate in the LA SCORES Field Trip to the Home Depot  Center.  I understand that this permission slip includes my permission for my child to participate, and I  assume all risks and hazards, including the risk of serious injury, and do hereby release and waive all  claims against LA SCORES, its officers, directors, coaches, sponsors, volunteers, other participants,  and the LAUSD School District.  I further grant permission for emergency first aid to be given in case  of injury. I understand that LA SCORES and the LAUSD School District assumes no responsibility for seeing to  it that the above named minor reports to activities at LA SCORES, and I, on my own behalf of this  minor, waive all claims for any liability arising or actions occurring before the minor has reported to  LA SCORES. I hereby release, discharge and/or otherwise indemnify LA SCORES, its employees, sponsors, Board of  Directors, and associated personnel, and the LAUSD School District against any claims by or on behalf  of the registrant’s participation and/or being transported to or from the same, which transportation I  hereby authorize.  My child has received a physical examination and has been found physically capable  of participating in the Program. Therefore I grant the LA SCORES’ Coaches to permission to act as my surrogate for my child in this  area of obtaining medical treatment by a doctor of medicine or dentistry.  I also assume financial re­ sponsibility for any medical treatment of my child. SIGNATURE OF PARENT / GUARDIAN: NAME___________________________________________________________  DATE___________

I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules  and instruction of LA SCORES coaches and staff.   My child has received a physical examination and  has been found physically capable of participating in this event.  Recognizing the possibility of physical  3685 Motor Ave., Suite 110● Los Angeles, CA 90064 Tel: 310-204-6455 ● Fax: 310-204-6455

injury, I assume all risks and hazards incidental to athletic participation and hereby release, discharge  and/or otherwise indemnify LA SCORES against any claim by or on behalf of the registrant as a result  of the registrant’s participation in this event and/or being transported to or from the same, which trans­ portation I hereby authorize. Parent / Guardian Signature_______________________________________________

3685 Motor Ave., Suite 110● Los Angeles, CA 90064 Tel: 310-204-6455 ● Fax: 310-204-6455