Florida Premier FC Free Clinics - Wesley Chapel 
Free Clinic are a community based event for anyone who is interested in getting out and playing! Open to ages 6-12! ANY LEVEL !
Dates: March 29, April 5 & 12
Times: 6:30 pm - 7:30 pm 
One Club One Family! 
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Players Name *
Player Birthdate  *
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Playing Experience  *
Parent Email *
Parent Phone Number  *
WAIVER
FL Premier FC Soccer Waiver: By checking the small box above and signing, you certify that you agree with the terms and conditions of our wavier. 

* ACCIDENT WAIVER AND RELEASE OF LIABILITY I hereby assume all of the risks of my child participating in Florida Premier FC , Including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them, or because of their possible liability without fault. I certify that my child is physically fit and has not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my child’s participation in this clinic. I acknowledge that this Accident Waiver and Release of Liability Form will be used by Florida Premier FC so my child may participate and that it will govern my actions and responsibilities at said FL Premier FC events. In consideration of my registration and by permitting my child to participate in FL Premier FC events, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A)I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my child’s death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to me or my child including traveling to and from this Clinic. THE FOLLOWING ENTITIES OR PERSONS: Florida Premier FC, and/or their coaches, agents, representatives or volunteers. (B) I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this Clinic, whether caused by negligence or otherwise. I acknowledge that this Clinic may carry with it the potential for death, serious injury, and personal loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, and lack of hydration. I consent and agree that Florida Premier FC, and/or their coaches, agents, representatives or volunteers may take photographs or digital recordings of me or my child as a participant during this event and use these in any and all media for training or promotional purposes. I waive any rights, claims or interest and I understand that there will be no financial or other remuneration. The accident waiver, release of liability and image release shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. PARENT/GUARDIAN WAIVER FOR MINORS (under 18 years old) The Undersigned parent and or natural guardian does hereby represent that he/she is, in fact, acting in such capacity, has consented to his/her child or ward’s participation in FL Premier FC events, and has agreed individually and on behalf of the child or ward, to the terms of the accident waiver and release of liability set forth above. The undersigned parent or guardian further agrees to save and hold harmless and indemnify each and all parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect on lack of such capacity to so act and release said parties on behalf of the minor and the parents or legal guardian. I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT ON MY OWN FREE WILL. THIS AUTHORIZATION SHALL REMAIN IN EFFECT FOR ONE YEAR FROM THE DATE IT WAS SIGNED.
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