ABCDEFGHI
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Columbus Indoor Soccer Challenge ADULT SOCCER LEAGUE TEAM ROSTER
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TEAM NAME ______________________________ PHONE NUMBER ____________________
Age Bracket
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TEAM CONTACT ___________________________ EMAIL ADDRESS ____________________
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FIRSTLASTD.O.B.ADDRESSCITY
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EMAILPLAYER’S SIGNATURE
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Waiver Form
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REPRESENTATIONS, ACKNOWLEDGEMENTS, AND AGREEMENTS:
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1. I hereby represent and certify that the age of the registrant listed is correct and acknowledge and agree that the registrant is physically fit
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to engage in both structured and unstructured activities at the Stars Indoor Sports.
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2. I acknowledge the inherent risk of serious injury or even death associated with soccer activities and I hereby release, discharge, and agree to
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indemnify and hold harmless Net Results LLC, its owners, managers, affiliates, and employees and
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Stars Indoor Sports, its owners, managers, affiliates, and employees from any and all claims by or on behalf of the registrant
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arising from the registrant’s participation in activities at the Stars Indoor Sports.
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3. I herby represent and certify that the registrant has adequate health insurance to cover any and all injuries occurring as a result of participation
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in soccer activities at the Stars Indoor Sports and as participant, I hereby consent to any and all emergency medical care for participant and
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agree to pay for same.
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I certify that the above information is correct
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Coach or Team Manager
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Date