LA Selecta ID Camp | LA 2023 Event registration
Event: Sunday 12/10,
Los Angeles, CA
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Player First Name *
Player Last Name *
Player Date of Birth *
MM
/
DD
/
YYYY
Gender *
Address *
City *
State *
Email *
Team Currently Playing For *
What Level *
Position
Parent / Guardian Name *
Phone Number *
We, the participant and the participants legal parent or guardian, hereby agree and acknowledge
the following:
(1) We agree to abide by the rules of the event/activity and its organizers and
sponsors.
(2) We recognize the inherent risk of serious or permanent physical injury and possible
death associated with youth soccer activities and games. In consideration for participation in the
event/activity (“Youth Programs”), we hereby release, discharge and/or otherwise indemnify and
hold harmless La Federacion de El Salvadoreña  de Futbol, US Federation, US Club, Cal South, its member organizations and sponsors, volunteers, their employees and
associated personnel, including the owners of fields and facilities utilized for the Youth Programs,
against any claim, lawsuit or written demand, including but not limited to any claims for personal or
physical injury or death, by or on behalf of the participant as a result of the participants participation in the Youth Programs and/or being transported to or from the same, which transportation we hereby authorize.
(3) We authorize verification of the participants date of birth from legal records to
be provided to a authorized representative for the limited purpose of verifying the
participant’s age and identity.
(4) We consent to emergency medical care prescribed by a duly
licensed Health Care Provider or Dentist. This care may be given under whatever conditions are necessary to preserve the life, limb or registrants well-being and we hereby agree to be financially responsible for all costs associated with such treatment.
(5) We consent to taking
photographs, video recordings, and/or sound recordings in documenting the activities of
programs and services. We hereby grant permission to use the
negatives, prints, motion pictures, video/audio tapings, or any other reproduction of the same for its affiliates; educational and promotional purposes in manuals, on flyers, the
internet, or other publications.
(6) In consideration of being allowed to participate in athletic
programming, sanctioned activities and events (collectively “Sanctioned Activities”) related to the
California State Soccer Association-South (Cal South) and member organizations (“RELEASEES”),
the undersigned acknowledges, appreciates, and agrees that: Participation in such activities
inherently includes possible exposure to and illness from infectious diseases including but not
limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may
reduce this risk, the risk of serious illness and death does exist; and, we (participant and parent of
participant of minority age) KNOWINGLY AND FREELY ASSUME ALL SUCH INHERENT RISKS,
both known and unknown, EVEN IF ARISING FROM THE ACTIVE OR PASSIVE NEGLIGENCE
OF THE RELEASEES or others and assume full responsibility for my participation.
We have read this release and waiver of liability and fully understand its terms. We understand that
we waive substantial rights by signing this form. We agree to waive all such rights above including
the right to file a legal action or assert a claim for personal or physical injury or death of any kind.
We sign this release form freely of our own free will.
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