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Congerville Eureka Goodfield Community Youth Recreation Association

Medical Release

Player Medical Release:

I hereby give my child permission to participate in the CEGCYRA Program. 

I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries, including death, damages, or losses which may be sustained as a result of participating in this program or utilizing CEGCYRA facilities. 

I agree to waive and relinquish all claims I may have as a result of using the facilities and participating in this program against the CEGCYRA and its officers, agents, servants and volunteers.

I further agree to indemnify and hold harmless and defend the CEGCYRA and its officers, agents, servants and volunteers from any and all claims resulting from any injuries, including death, damages and losses sustained by me or my child arising out of, connected with, or in any way associated with the CEGCYRA Programs. 

In addition, I give my child permission to be treated by hospital and emergency personnel in the event of an emergency should I be unavailable.

Your acknowledgement counts as your signature.

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P.O. Box 161 
Eureka, Illinois 61530

Email Us: [email protected]
Phone : 309-409-5510
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