Soccer Fundamentals Registration Form for Summer Session

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Email *

Player Name *

Player Date of Birth *

YYYY

Player Shirt Size *

Parent(s) / Guardian(s) Name(s) *

Player Home Address *

Primary Phone Number *

Secondary Phone Number

Primary Email Address *

Secondary Email Address

Payment Preference? *

Venmo

Paypal

Check / Cash

If you are using either a venmo or paypal account, please enter the service and username to process a payment request. If paying by check/cash, you can simply reply "N/A" here. *

Soccer Fundamentals Waiver of Liability & Release Form

This for must be completed for each soccer player (participant) and, if the player is under 18-years old, must be signed by the player's parent or legal guardian. No player will be allowed to participate in Soccer FUNdamentals activities, clinics, or sessions without this form, properly executed, and on file.

Participant's Name: *

Participant's Date of Birth (mm/dd/yyyy) *

YYYY

I, the undersigned, in consideration for my voluntary participation in organized soccer, do hereby willfully acknowledge that my signature below attests to my understanding and agreement that:

My player status will be kept in good standing. I will not compromise myself in such a way as to do harm to Soccer FUNdamentals or any leagues or tournaments I may participate in, knowing that players may be dismissed from participation, with possible loss of payment of dues, for violent conduct or unsportsmanlike behavior on or off the field of play. I agree to pay for any and all damages to any property or indemnities caused by me willfully, negligently, or otherwise.

Soccer is a physical, contact, sport that involves the risk of injury. I assume all risks and hazards associated with my participation in soccer practices and games and have no illness, disease or existing in jury or physical defect that would be aggravated by my participation. I will inform my coach if this status changes. I further acknowledge that this risk may involve loss or damage to me or my property, including the risk of death, or other unforeseen consequences, including those which may be due to the unavailability of immediate emergency medical care. I will wear shinguards, properly-fitted and appropriate shoes, and other protective equipment (e.g., mouth-pieces), as provided by soccer rules, to all events.

Soccer FUNdamentals has general liability insurance, but does no have personal injury insurance that covers my participation. Therefore, I should have a current, active, personal injury insurance policy in force, which covers my participation. Under any condition, I am responsible for any and all medical expenses arising from my participation, both in practices and games and while traveling to and from these events. I have the right and responsibility to inspect the equipment and facilities prior to events and, if I believe that anything may be unsafe, I will advise the coach or supervisor of the condition and may refuse to participate. Participation assumes consent.

I authorize my photograph, picture or likeness, and voice to appear in any documentary, promotion (including advertising), television, video, or radio coverage of the league, clinic, camps, or tournament, without compensation.

I authorize that an unaltered copy of this form may b e generated and given to the officers or directors of other leagues or tournaments in order to allow my participation in their soccer programs, if the form is required and I have requested to participate.

I hereby release, waive liability, discharge, hold harmless, indemnify, and covenant not to sue, the United States Soccer Federation, the State Association, Soccer FUNdamentals LLC, any league or tournament and their associated directors, administrators, officers, managers, employees, coaches, trainers, volunteers, sponsors and advertisers, and other agents, estates or executors, from any and all liability incurred in the conduct of, and my participation in, their soccer programs. This includes owners, lessors, and lessees of premises, municipalities, government agencies, successors, heirs, and assigns.

I have completely read this document and fully understand its contents. I acknowledge that I have given up substantial rights by accepting this document and that I do so voluntarily. My signature attests to this on behalf of myself and my executors, personal representatives, administrators, heirs, next-of-kin, successors, and assigns.

For those individuals eighteen (18) years of age and older:

Participant's Name

By Clicking "I agree" below I consent for this to act as my electronic signature for this form.

I agree

Date Signed (mm/dd/yyyy)

YYYY

For those individuals under the age of eighteen (18) years (minor):

As the parent and natural guardian or legal guardian of the participant, I hereby agree to the foregoing Waiver of Liability and Release for, and on behalf of, the participant (player/minor) named above. I hereby bing myself, the minor, and all other assigns to the terms of the Waiver of Liability and Release. I represent and certify that I have the legal capacity and the authority to act for, and on behalf of, the minor in the execution of this Waiver of Liability and Release.

Parent or Guardian Name

By Clicking "I agree" below I consent for this to act as my electronic signature for this form.

I agree

Date Signed (mm/dd/yyyy)

YYYY

A copy of your responses will be emailed to the address you provided.

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