Kokomo Adult Soccer League Registration and Liability Release Form - DOC

Document Sample
Kokomo Adult Soccer League Registration and Liability Release Form - DOC Powered By Docstoc
					                  KOKOMO SOCCER CLUB's                                                   Registration Form
                 Kokomo Adult Soccer League                                                2006 Season

Name
Driver's License Number                                                                      Email completed
(required for player pass)                                                                     form to your
                                                                                             CAPTAIN and to:
Date of Birth                                                                                     ksc@
                                                                                            kokomosoccerclub.
Email
                                                                                                   com
Phone                            (     )       -
Street Address
City, State, Zip Code
Shirt Size                       M                  L                 XL                  XXL
Name of Team Captain
(enter "No Captain" if looking
to join a team)
Pertinent Medical
Conditions or Medications
Doctor's Name
Doctor's Phone                   (     )       -

                             WAIVER AND RELEASE OF LIABILITY
I acknowledge that soccer necessarily and inherently involves intense physical effort, play on adverse field
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. I willingly and voluntarily accept and assume all such
risks of participation. I further acknowledge that the Kokomo Soccer Club is administered by volunteers rather than
by paid professionals. In exchange for permitting my voluntary participation in the Kokomo Soccer Club's Kokomo
Adult Soccer League, for myself and on behalf of my heirs, assigns and next of kin, I hereby waive any and all
claims of personal injury, including severe bodily injury, death, and damage to personal property relating to my
participation in the Kokomo Adult Soccer League, including but not limited to playing soccer on the Kokomo
Soccer Club property and using any equipment or facilities on the Kokomo Soccer Club property. If I am injured in
any way during this activity I will not hold responsible the Kokomo Soccer Club, its employees, volunteers,
officials, sponsors and/or other representatives, even if my injuries result from the negligence of the Kokomo Soccer
Club, its employees, volunteers, officials, sponsors, and/or other representatives.

I HAVE READ THE ABOVE WAIVER AND RELEASE OF LIABILITY, FULLY UNDERSTAND ITS TERMS,
UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY MY SIGNING THIS FORM AND AGREEING
TO THESE TERMS, AND I SIGN THIS FORM AND AGREE TO THESE TERMS FREELY AND VOLUNTARILY AND
WITHOUT INDUCEMENT OF ANY KIND.
I UNDERSTAND THAT CHECKING THE BOX BELOW AND EMAILING THIS COMPLETED FORM
TO KSC@KOKOMSOCCERCLUB.COM ACTS AS MY SIGNATURE.

I AGREE TO THE ABOVE TERMS: