ICYAA
4th Grade Waiver for:
Players Name:_______________________________________________________________
SPORT :____________________________________________
YEAR:______________________________________________
Dear Parent/Guardian
The waiver form below is required in order for any and all 4th grade athletes to
participate at ANY varsity level. Failure to complete the form and deliver it to the
head coach, which will be delivered to the ICYAA executive committee for approval,
will result in the athlete not being able to participate at the varsity levels of the
respective sport.
1. CONSENT TO ALLOW ATHLETE TO PARTICIPATE AT THE VARSITY LEVEL
I hereby understand that my child may be asked to play as a 4th grader at the varsity
level when there is no JV team available.
I also understand that my child may be asked to play as a 4th grader at the varsity
level due to advanced skill level and for the purpose of athletic placement and
advancement.
A. I hereby authorize and consent that my child, while enrolled as a 4th grader at a
participating school, may participant in the ICYAA at the Varsity level.
B. In the event that THERE IS a Junior Varsity team, I understand that the ICYAA
MAY ACCEPT OR DECLINE the following waiver without further review.
C. I hereby understand that the ICYAA executive committee has full authority to
revoke the following waiver for the remainder of the respective sports year.
_____________________________________________ _________________________
Signature of Parent/Guardian Date
2. WAIVER AND RELEASE OF LIABILITY
In consideration of being allowed to participate at the Varsity level while a 4th grader
at a participating school, the athlete and the parent/guardian of the athlete do hereby
agree, for ourselves, our heirs, executors and administrators, to release, hold
harmless and forever discharge the ICYAA, their employees, officers, directors,
administrators, agents, representatives, students, affiliates, subsidiaries, successors,
and assign, for and against any and all claims, actions, causes of action, suits,
judgments, and demands whatsoever arising directly or indirectly in connections with
the above waiver. By signing below, I acknowledge that I have read and understand
this form and further understand that the terms herein are contractual and not a mere
recital.
__________________________________________ _______________________
Signature of Parent/Guardian Date