Adaptive Soccer For All Players
Adaptive Soccer For Youth Who Experience A Disability

ASAP- Adaptive Soccer for All Players is a program of Wildcat Soccer Club intended to provide
opportunities to enjoy our sport for any and all youth in the Wildcat area who experience a
disability. Coaches and volunteers will take time to learn about each individual player’s names
in order to develop and tailor activities meant to provide fun opportunities to learn in a safe
soccer setting.

Adaptive Soccer will be held in Waymart, Pa at the Robert D. Wilson Elementary School. The program will run for four Sundays starting Sept 10, 2023 - October 1, 2023, starting at 1:00pm.

Registration: $15.00 (Includes a T-shirt)
Completed Forms and/or Payments can be mailed to: 
Wildcat Soccer Club, PO Box 670, Waymart Pa 18472
by July 31, 2023

Payments can be made at any of the In-person dates:
Western Wayne Middle School Foyer: June 1: 6-7pm

Any questions please email:
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Email *
Player's First and Last Name *
Age *
Birthdate *
Address *
Shirt Size *
Disability: *
Medical Restrictions *
Physician's Name: *
Physician's Telephone: *
Soccer Experience/knowledge *
Understanding of the Game: *
1 - No experience
5 - Knows the rules
Running Ability: *
Kicking Ability: *
Catching Ability *
Retrieving Ability *
Buddy Required *
Wheelchair or Assistive Device *
Comments: *
Parent/Guardian Full Name *
ASSUMPTION OF RISK / WAIVER OF LIABILITY / INDEMNIFICATION AGREEMENT In consideration of being allowed to participate on behalf of (Wildcat Soccer Club) athletic program and related events and activities, the undersigned acknowledges, appreciates, and agrees that:1. Participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist; and, 2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releasees or others, and assume full responsibility for my participation; and,3. I willingly agree to comply with the stated and customary terms and conditions for participation as regards protection against infectious diseases. If, however, I observe and any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS S.A.Y. Soccer, U.S.A., their officers, officials, coaches, members, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“releasees”), while participating in activities of any kind whether sponsored by or under the supervision of S.A.Y. Soccer U.S.A. and with respect to any and all illness, disability, death, or loss or damage to person or property, whether arising from the negligence of 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.FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases.Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child’s/ward’s presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law. *
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