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NLSA/NLSTA/WXFC Non-Registered Player Waiver Form
To be filled out by a non-minor player or the parent or guardian of a minor player
Player's First Name *
Your answer
Player's Last Name *
Your answer
Parent First & Last Name (if player is a minor) - If player is adult, enter "NA" *
Your answer
Email address (or parent email address if player is a minor) *
Your answer
Cell phone number (or parent cell phone number if player is a minor) *
Your answer
Emergency Contact *
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Emergency Contact Cell phone number *
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APPROVAL AND MEDICAL RELEASE Recognizing the possibility of physical injury, I, the above-named player OR parent/guardian of the above-named player, a minor, do hereby release, discharge and/or otherwise indemnify the Next Level Soccer Academy, Inc., Next Level Soccer Training Academy, LLC, Washington Crossing FC, and their affiliated organizations, and their respective officers, coaches, trainers, directors, volunteers, referees, managers, board members, tournament hosts and their officials, employees and associated personnel (collectively referred to as "the entities"), including the owners of the fields and facilities utilized for the Programs ("Programs," as used herein, means games, tournaments, clinics, practices, training, and/or soccer activities or social events organized by the above entities or their affiliated organizations), against any and all claims by or on behalf of the above-named player as a result of such player's participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize by the officer, coach or agent(s) of the above entities. The above-named player has received a physical examination by a physician and has been found physically capable of participating in the Programs. I, the above-named player OR the parent/legal guardian of the above-named player, hereby give my consent to have an athletic trainer, doctor of medicine or dentistry, or other medical professional provide the above-named player with medical assistance and/or treatment and agree to be responsible financially for the reasonable cost of such assistance and/or treatment. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of the above-named player. * *
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Please type your full name as your signature *
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