Waiver and Release from Liability

Name: _____________________________________________________________________________

Home Address: _____________________________________________________________________

____________________________________________________________________________________

Contact email: ______________________________________________________________________

Contact phone: _____________________________________________________________________

Age: _____________________________ Date of Birth: _____________________________________

I certify that I desire to play for the Boca Raton Football Club (the Team), and its affiliated leagues, I agree to the following on behalf of myself, my executors, administrators, heirs, next of kin successors and assigns: a) I waive, release and discharge from any and all claims or liabilities for death, personal injury or damage of any kind, which arise out of, or relate to my participation in, or my traveling to and from the Boca Raton Football Club tryout, practice, or game, which includes the following persons or entities: The American Premier Soccer League, The National Premier Soccer League, The United Premier Soccer League  the Team, the Team Owners, Sponsors, Players, Coaches, the Officers, Directors, Employees, Representatives, and Agents of any of the above; b) I agree not to sue any of the persons or entities mentioned above for any of the claims of liabilities I have waived, released or discharged herein; c) By signing this release I acknowledge that I am not eligible to receive worker’s compensation as I am not employed by the Team; d) I indemnify and hold harmless the person or entities mentioned above from any claims made or liabilities assessed against them as a result of my actions; e) In the event that I cannot respond personally in an emergency, I hereby give permission to the physician selected by the Team to secure and administer treatment, including hospitalization for me; f) I understand and acknowledge that there are inherent risks and dangers in activities and programs offered by the Team; g) I give the Team the right and permission to use, re-use, electronically reproduce, publish and re-publish photographs and videos that may feature or include me; h) I also grant permission to use my name in connection with the Team; and i) I ensure that I am in good condition, approved by a physician, to participate in physical activities.

I HEREBY AFFIRM THAT I HAVE READ THIS DOCUMENT AND UNDERSTAND ITS CONTENT, AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY.

Player’s Signature: __________________________________________ Date: _____________________