TEAM INFORMATION:

Team Name:

State: City:Coach:

Coach Tel Number:

Age Group: U8 Coed U10 Boys U10 Girls U12 Boys U12 Girls U14 Boys U14 Girls U16 Boys U16 Girls U19 Boys U19 Girls High School Open Men Men OV/30 Men OV/40

PLAYER INFORMATION:

First Name:              Last Name:                 Gender: Gender Female Male

Address:   City:     State:     Zip Code:

Home Phone :   Cell Phone:   DOB:

Birth Date:(mm/dd/yyyy):  Futsal (Indoor) Experience: No Yes Outdoor Soccer Experience: No Yes

PARENT/GUARDIAN INFORMATION:

Guardians #1

First Name:   Last Name: Relationship:

Home Phone:  Cell Phone: Work Phone:

Email:

Guardians #2

First Name:   Last Name: Relationship:

Home Phone:  Cell Phone: Work Phone:

Email:

EMERGENCY CONTACT INFORMATION:

List any medical problems or prohibitions the player has:

Doctor to notify in emergency:  Doctors Phone:-- ext:

Person to notify in emergency:  Emergency Contact's Phone:--

Consent and Liability Wavier - Release of all claims (must be signed to participate).

As lawful consideration for being permitted to participate in the Futsal International indoor tournament, league, camp, training, clinic, or facility I agree that I will not make a claim against, sue, attach, the property of or prosecute Futsal International, or American Futbolito Sportplex Inc. and their agents, sponsors and employees for damages for death, personal injury or property damage which I may sustain as a result of my participation in this sporting activities. This release is intended to discharge in advance American Futbolito Sportplex Inc. and their agents, sponsors and employees from and against any and all liability, including for negligent actions, arising out of misconduct of American Futbolito Sportplex Inc their agents, sponsors and employees. I FUTURE UNDERSTAND THAT SPORTS INVOLVE PHYSICAL CONTACT BETWEEN PLAYERS, THAT SERIOUS ACCIDENTS OCCASIONALLY OCCUR DURING SUCH SPORTING ACTIVITIES, AND THAT PARTICIPANTS IN SUCH SPORTING ACTIVITIES OCCASIONALLY SUSTAIN SERIOUS PERSONAL INJURIES (INCLUDING DEATH) AND / OR PROPERTY DAMAGE AS A CONSEQUENCE THEREOF, KNOWING THE RISK OF PARTICIPATION, NEVERTHELESS, I HEREBY AGREE TO ASSUME THOSE RISK AND TO RELEASE AND HOLD HARMLESS AMERICAN FUTBOLITO INC AND THEIR AGENTS, SPONSORS AND EMPLOYEES WHO (THROUGH NEGLIGENCE OR CARELESSNESS) MIGHT OTHERWISE BE LIABLE TO ME (OR MY HEIRS OR ASSIGNS) FOR DAMAGE.

                        I attest that I am physically fit and have no know medical conditions which prohibit participation in this a sport. I agree to follow all laws, rules and guidelines regulating the conduct of the sport league, camp or clinic. I understand and agree that I am sole responsible for the mechanical and / or operating condition of any and all sporting equipment I use, and I agree to continuously inspect and maintain that, even if I have obtained any of the equipment from American Futbolito Inc, their agents, sponsors and / or employees.                                       I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between me and American Futbolito and their agents, sponsors and employees, and I have signed it of my own free will. I also agree that American Futbolito Sportplex Inc. and their agents, sponsors and employees, may us my photograph in the future promotions.

COMMUNICATION INFORMATION:

Enter E-Mail:

Player Signature:

Parental consent if needed

Parent Signature:

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