Individual Registration Written by vividcandi, April 16th, 2016 Soccer Signup (Individual) Player's Name* First Name Last Name Player's Gender*MaleFemalePlayer's Date of Birth* MM DD YYYY Player's Team Name*Parent Name* First Name Last Name Email* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*I HEREBY CERTIFY THAT MY CHILD IS IN GOOD HEALTH AND MAY PARTICIPATE IN ALL ACTIVITIES. I WILL NOT HOLD ELITE SPORTS CLUB RESPONSIBLE IN THE EVENT OF AN ACCIDENT OR INJURY AS A RESULT OF THEIR PARTICIPATION. I ALSO GIVE PERMISSION FOR MY CHILD TO BE GIVEN EMERGENCY TREATMENT AT A LOCAL HOSPITAL. Parent / Guardian Signature* RELEASE OF LIABILITY PLEASE READ AND CHECK THE BOX BELOW TO VERIFY THAT YOU AGREE TO THE TERMS OF THE RELEASE. The parent/guardian having legal custody of the Player, a minor, for myself and on behalf of aforementioned Player, acknowledges and understands that participation in Elite Sports Club LLC necessarily involves play in adverse conditions, contact with considerable force, and risk of severe, permanent physical injury including, bruises, scrapes, strained, sprained or torn muscles, tendons or ligaments, broken bones, dislocation of joints, concussion, brain damage, nerve and spinal cord injury, paralysis and death. For myself, and on behalf of the aforementioned Player, we willingly and voluntarily accept and assume all such risk. For myself and on behalf of the aforementioned Player, I further acknowledge (i) that Elite Sports LLC is voluntarily making the practice sports facilities including but not limited to, Crossroads School, Memorial Park, JEM Center Beverly Hills, Angelo Sports Facility and Pepperdine University, available for play and practice for the Player’s team and (ii) that Elite Sports Club LLC shall not be liable for any damages for personal injuries sustained by the Player in, on or about the practice premises. The undersigned on behalf of himself/herself and on behalf of the Player hereby releases, discharges, and agrees to indemnify, defend and hold harmless Elite Sports Club LLC., its members, owners, officers, employees, contractors and agents from and against any losses or expenses (including attorneys’ fees and costs) from any and all claims, demands or actions arising out of or relating to the use or intended use of the practice sports facilities, including, without limitation, any claim for personal injuries or death or other damage resulting from or arising out of the acts or omissions of Elite Sports Club LLC, its members, owners, officers, employees, contractors, agents and/or any other person related to playing or practicing at any or the aforementioned practice facilities. I HAVE READ THE ABOVE ASSUMPTION OF RISK AND WAIVER AND RELEASE OF LIABILITY AND ACKNOWLEDGE AND FULLY UNDERSTAND THE TERMS OF EACH, UNDERSTANDING THAT I AND THE PLAYER HAVE GIVEN UP SUBSTANTIAL RIGHTS IN MY SIGNING THIS FORM AND AGREEING TO THESE TERMS. I SIGN THIS FORM AND AGREE TO THESE TERMS ON BEHALF OF MYSELF AND THE PLAYER FREELY AND VOLUNTARILY WITHOUT INDUCEMENT FOR MYSELF AND ON BEHALF OF THE PLAYER.* I have read and agree to the terms of the Release of Liability. Parent/Guardian check here. Comments are closed.