SSA Coweta Academy and Select Tryouts

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Thank you for your interest in our Coweta Academy/Select program!

A parent or guardian is required to complete this form on behalf of the participant.

Player First Name *

Player Last Name *

Player Gender

Female

Male

Clear selection

Player DOB *

YYYY

Current Club and Team *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Address

City

ZIP

E-mail Address *

Phone Number (no spaces - 1234567890) *

Covid Waiver: COMMUNICABLE DISEASE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT In consideration of being allowed to participate in any way in the program, related events, and activities, I, for myself, for personal representatives, assigns, heirs, and next of kin, acknowledge, appreciate, and agree that: I am aware that participation includes potential risks to the participant named above of exposure directly or indirectly arising out of, contributed to or by, or resulting from an outbreak of any communicable disease, including, but not limited to, the virus “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, which is responsible for Coronavirus Disease (COVID-19), and/or any mutation or variation thereof. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, COVENANT NOT TO SUE, DISCHARGE, INDEMNIFY, AND HOLD HARMLESS US SOCCER INC., US CLUB SOCCER INC., GEORGIA STATE SOCCER ASSOCIATION, INC., COBB FUTBOL INC. (DBA Southern Soccer Academy) and their officers, directors, officials, agents, employees, other participants, sponsors, advertisers, its member affiliates and, if applicable, owners and lessors of premises used to conduct any sponsored or sanctioned event (“Releasees”), from any and all claims, demands, losses, damages, and liability arising out of or related to any ILLNESS, INJURY, DISABILITY OR DEATH I may suffer, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. Notwithstanding the risks associated with any communicable disease, including, but not limited to, the virus “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, which is responsible for Coronavirus Disease (COVID-19), and/or any mutation or variation thereof, which I readily acknowledge, I hereby willingly choose to participate and assume the risk of doing so. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. *

Required

General Waiver: I, being the Parent/Guardian of the participant listed above, hereby give electronic approval to his/her participation in all tryout activities. I recognize the possibility of serious injury to such player and assume all risks and hazards related to such participation. I hereby release, discharge, absolve, and indemnify and agree to defend and hold harmless, Cobb Futbol Club Inc, DBA Southern Soccer Academy and it’s affiliates, sponsors, employees, coaches, representatives and agents from and with respect to any claim, cause of action, liability, expense or obligation arising in connection with, or related to, such players participation in the tryout and related activities. I hereby grant permission to the club's coaching staff, in my absence, to authorize and obtain medical care and treatment from any licensed physicians, nurses or medical personnel to the extent deemed necessary by such physician, nurse or medical personnel and I assume full financial responsibility for said treatment. *

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