Player’s Name ____________________________________________ Date of Birth __________________
Gender ________ Medical Conditions _______________________________________________________
Player’s Address ________________________________________________________________________
Home Phone __________________________ email ____________________________________________
Current Team’s Name ________________________________ Current Coach________________________
Is Player trying out for: Challenge Only _____ Classic Only _____ Both ______
Parent Information
Mother/Guardian _________________________ Street Address___________________________________
City___________________________________ Zip___________ Home Phone_______________________
Employer_____________________________________________ Work Phone________________________
Father/Guardian ___________________________Steet Address (if different)_________________________
City ____________________________________ Zip __________ Home Phone_______________________
Employer _____________________________________________ Work Phone _______________________
Waiver/Release of Liability
I intend to allow my child to participate in Seashore Soccer League. I
recognize that soccer is a collision sport and that the risk of physical injury is
inherent to the sport. I certify that my child is medically sound and physically fit to
play soccer.
I am aware of and voluntarily assume all risks – regardless of their causes – to my child, including accidental injury or injury caused by the negligence of others, arising from his/her participation in Seashore Soccer League and/or its activities, including participation in the sport of soccer. Such risks specifically include but are not limited to- and I certify that I will make my child aware of – the danger of significant personal injury (including death) associated with soccer goals which may tip over or collapse when used as a device on which to climb, hang or otherwise play or when improperly moved or secured.
I understand that it is not the responsibility of Seashore Soccer League or its representatives to serve as guardians of my child’s safety. I am responsible for my child’s protective equipment and the use by my child of protective equipment, including shin guards and mouthpieces and for the condition of his/her cleats if he/she chooses to wear them. Furthermore, I understand those weather conditions and conditions of the playing field can vary and can increase the risk of personal injury. I will note the weather conditions and the condition of the field, and I voluntarily assume all risks to my child arising from such condition.
In consideration of Seashore Soccer League sponsoring its program, I will not hold Seashore Soccer League or any if its officers, employees or agents liable in damages for injuries my child might sustain while participating with Seashore Soccer League and any activities sponsored by it. I hereby release and forever hold harmless Seashore Soccer League and all of its officer, employees of agents from an liabilities, claims, damages, or losses arising from or in any way relating to my child’s participation in the soccer club.
My signature below indicates that I fully understand the Release and Assumption of Risk, which I am voluntarily signing, will bind me, my heirs, and my personal representatives.
Parent Signature ______________________________ Date_____________