I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical tech, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based on information provided herein. I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with soccer, and hereby release, discharge and otherwise indemnify the club, US Club Soccer, their sponsors, the USSF and its affiliated organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the soccer player named above as a result of that player's participation in US Club Soccer programs and/or being transported to or from the same, which transportation I hereby authorize.

I verify that I am the guardian of the child listed and that they are in good health and does not have a history of any injury or illness that could endanger their safety during their participation in athletic activities. I further understand the inherent risk involved in participation in athletic activity includes death, permanent paralysis, or permanent bodily injury. I have read the above statements and I am willing to voluntarily assume full responsibility for the risks while my son or daughter participates in the athletic tryout. I hereby waive any and all liability, including negligence, medical claims, causes of action, and rights of entitlement, suits or damages against and release Impact City FC, or any of its coaches, employees, volunteers or representatives, as a result of or in conjunction with athletic participation in the athletic tryout. I further understand and acknowledge that Impact City