REGISTRATION FORM
|
TEAM ROSTER
|
||||
|
NAME
|
DOB
|
EMAIL
|
PHONE
|
T-SHIRT SIZE
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
I, participant or the parent/guardian of the registrant,( if a minor), agree that I and the registrant will abide by the rules of Fast Break 4v4, NorthStar Soccer Inc, USClub Soccer and the USSF. Recognizing the possibility of physical injury associated with soccer. I hereby release, discharge and/or otherwise indemnify Fast Break 4v4, Grand Traverse Soccer League, NorthStar Soccer Inc, USClub Soccer and the USSF, and any affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the soccer programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the programs. MEDICAL TREATMENT As the participant or parent or legal guardian of a registered minor, hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well-being of my dependent. |
||||
|
|
||||
| I have enclosed $120 for team registration fee. I understand that this fee is not refundable. I have read and agree to all the conditions above. |
||||
Signature: |
Date: |
|||
|
|
||||
|
Print & mail to:
Fast Break 4V4 Registration |
Questions:
 |
|||