5v5 Registration - TURF FIELD
Quaker Elite Soccer Club
Winter Soccer 5v5 Draft League - TURF FIELD
Ages: 8 - 13 boys & girls
Location: Penn Charter, Front Turf
Dates: Dec 7, 8, 14, 15, 21, 22, 28, 29
Time: 40-minute game played Saturday and/or Sunday between 3-6 pm
Cost: $100 (6 game minimum)
Registration Deadline November 23rd
Checks made payable to Quaker Elite Soccer Club
Questions email: staff@quakerelitesoccer.com
Email address *
Player name *
Your answer
Player birth year *
Your answer
Current club/team *
Your answer
Parent Name *
Your answer
Phone number *
Your answer
I hereby agree as follows, intending to be legally bound hereby: In consideration for permission of the Quaker Elite Soccer Club and the affiliates of either or both of them and all their respective employees, officers, directors, agents, coaches, officials, and volunteers "Releasee(s)" allowing player to participate in their activities,1) I hereby release, waive and forever discharge "Release(s)" from and against any and all liabilities, claims, demands, actions, causes of action, damages, costs or expenses for personal injury, including but not limited to bodily injury and/or death and/or property damage which I or player may sustain and which are or may be caused by the act of or omission of player his fellow player(s) and/or any of the "Release(s)," except where the "Release(s)" act or omission constitutes gross negligence or willful misconduct.2) I agree to indemnify the "Release(s)" from any personal injury or property damage caused by the negligent or intentional act of player while participating in any of "Release(s)" activities.3) Further, I hereby grant unto "Release(s)" my power of attorney to act as if here were I, in my place and stead, in case where medical attention must be administered to player, thereby allowing "Release(s)" to cause medical attention, including but not limited to treatment for accident or sickness, to be immediately given, whether by "Release(s)" paramedical personnel or physicians, until such time as I can be made completely aware of and can act upon the circumstances causing the need for medical attention. As part and parcel of this grant, I hereby release "Release(s)" as set forth in Paragraph (1) hereof and agree to indemnify and hold "Release(s)" harmless from any and all costs for the above referenced medical treatment. *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Jim Adair. Report Abuse