CF Empire Fall 2021 Rec Registration Form
Due by 7/31/21
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Email *
Player First Name *
Player Last Name *
Player Date of Birth *
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Player Grade Level (as of September 2021) *
Player Gender *
# of Years of Soccer Experience *
Address *
Primary Phone # (Will be used for coach contact purposes) *
Primary Email (Will be used for coach contact purposes) *
Player Shirt Size *
Parents/Guardian Name *
Parents/Guardian Name *
Emergency Contact (Not Listed Above) / Phone # / Relationship *
Medical Information - Known Allergies *
List Allergies Here *
Interested in Volunteering
Special Requests
Payment Options - $45 per player - if paid by 7.31.21 / $50 per player if paying 8.01.21 or later *
COMMUNICABLE DISEASE RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT - In consideration of being allowed to participate in any way in the program, related events and activities, I the undersigned, acknowledge, appreciate, and agree that: I am aware there are risks to me of exposure to directly or indirectly arising out of, contributed to, by, or resulting from an outbreak of any and all communicable disease, including but not limited to, the virus “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, which is responsible for Coronavirus Disease (COVID-19) and/or any mutation or variation thereof. I acknowledge my responsibility not to play or practice if I am exhibiting symptoms of COVID-19. If, however, I observe any symptoms during my participation or presence at a game or practice, I will remove myself from participation, and bring such to the attention of my coach or team official immediately. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS CF Empire (Empire United Soccer Association), its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any ILLNESS, INJURY, DISABILITY OR DEATH I may suffer, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. This is to certify that I, as parent/guardian with legal responsibility for this participant, do acknowledge my responsibility to restrict my child from play or practice if they exhibit any symptoms of COVID-19, and consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. I agree to my child having their temperature taken and recorded prior to them participating in a CF Empire Soccer event. By checking this box, I/we acknowledge having read and agree to the above statements and serves as my electronic signature. *
Required
PERMISSION TO PARTICIPATE IN THE CF EMPIRE SOCCER PROGRAM: To the best of my knowledge, my player is in good health and has my permission to participate in the CF Empire soccer program. I, the parent or legal guardian of the above named player, do hereby give my consent for him/her to participate in all of the soccer activities associated with the club. I do assume the entire risks and hazards incidental to the conduct of the soccer activities, transportation to and from the activities, and I do absolve, indemnify and hold harmless the Empire United Soccer Association, it’s organizers, coordinators, officers, sponsors, coaches, referees, and supervisors. I likewise release from responsibility any person transporting my child to or from soccer activities, which transportation I do hereby authorize. MEDICAL RELEASE: Should my child become ill or sustain an injury, I authorize the designated coach to provide for medical treatment in an emergency. This would include the calling of a licensed physician for treatment, or the transportation or arrangement for transportation of the above named participant to a medical emergency room. I understand that an effort will be made to contact me in case of an emergency and that the cost, if any, for the treatment will be covered by myself or my medical insurance policy. I shall indemnify, hold free and harmless, assume liability for any costs and expenses of any kind that may have arisen or are alleged to have arisen out of participation in. By checking this box, I/we acknowledge having read and agree to the above statements and serves as my electronic signature. *
Required
Date *
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