Tryout/Clinic Waiver
You must submit a copy of this form for each child attending a WSSL tryout or clinic. One per player.
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Last Name *
First Name *
Date of Birth *
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DD
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Gender
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Parent/Guardian First and Last Name *
Contact Number - where parent can be reached during tryout/clinic and for follow up *
Contact Email - where parent can be reached during tryout/clinic and for follow up *
Pediatrician Name and Phone Number *
Emergency Contact Name and Phone Number (other than parent/guardian above) *
Certification - As parent/guardian of the above player(s), I certify that he/she is in excellent health and has no physical, mental or emotional problems that are likely to prevent participation in strenuous physical play at soccer tryouts. I agree to hold harmless AYSO, West Side Soccer League, and their respective agents, volunteers, and employees. I hereby release them from all liability on account of injuries sustained by player(s) while participating in soccer activities. I give permission for player(s) to be medically treated for illness occurring or injury sustained during such participation and certify that he/she is covered by medical insurance which will reimburse the parties for expenses incurred by them, their agents and employees on account of medical treatment ordered at their discretion and also to indemnify them for any expenses not reimbursed by such insurance. I give consent for player(s) to be photographed, videotaped, or filmed while participating in soccer activities, and for the resulting photos to be used by AYSO,West Side Soccer League, and their agents for educational and promotional purposes. I have read and understand the above. *
Electronic Signature - By entering your name below you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request to sign a paper copy instead. By entering your name below you are waiving that right. After consent, you may, upon request, receive a paper copy of the electronic record. No fee will be charged and no special hardware or software is required to view it.   PLEASE ENTER YOUR FULL LEGAL NAME: *
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