APPLICATION TO WAIVE AGE LIMIT AND RELEASE
_________________________________, Parent, legal guardian or person having care,
custody and control of the following child_____________________________________,
requests that the Community Services Department waive the minimum age
requirement for participation in the City of Peoria Youth Sports Program for the
following reason:
(a) Child will turn the minimum age during the playing season for the program
that the child desires to participate in.
(b) Child has played at least two prior consecutive seasons in the same sport
as waiver is requested
(c) Child's Weight and Height is ______________________, which is closer in
size and weight to participants in the ______________age group as
determined by the Community Services Department.
(d) Other__________________________________________________
_________________________________________________________
By making this Application, I understand that my Child will be playing in Youth Sports
with children of an older age. There may be greater chances of accidental injury to my
child than with children of their age group. The City provides coaching and
supervision appropriate to the age of the Child. I understand that my Child will be
playing Youth Sports with children who may be physically, emotionally and mentally
more mature than my child.
By making this Application, I understand that I am responsible for consulting with any
medical, psychological or other professional providers regarding the consequences of
permitting my child to participate in the Youth Sports Program, based on a waiver of
the minimum age requirement.
By Signing this Application, I agree to release the City of Peoria, Arizona, its elected
and appointed officials, employees, agents and contractors from any liability arising
out of the granting of this application. By making this release, I am waiving and
releasing any right to a claim against the City and a trial of such claim before a judge
or jury, including but not limited to the right to obtain discovery and call and examine
witnesses in such a proceeding.
My signature below indicates that I have read and understand all the provisions of this
application and releases.
Dated______________________ _____________________________
Name of child
_____________________________
Name of parent, legal guardian or
Person having care, custody and
Control of Child.