Camper Name *

First Name

Last Name

Camper Date of Birth *

MM

DD

YYYY

Parent Name *

First Name

Last Name

Parent Phone number *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Emergency Contact Phone Number *

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Waiver

I, the undersigned, in consideration for my voluntary participation in organized soccer, do hereby willfully acknowledge that my signature below attests to my understanding and agreement that: My player status will be kept in good standing. I will not compromise myself in such a way as to do harm to the league or tournament, knowing that players may be dismissed from participation, with possible loss of payment or dues, for violent or unsportsmanlike behavior on or off the field of play. I agree to pay for any and all damages to property or indemnities caused by me willfully negligently, or otherwise. Soccer is a physical, contact, sport that involves the risk of injury. I assume all risks and hazards associated with my participation in the sport. I am in proper physical condition to participate in soccer practices and games and have no illnesses, disease, or existing injuries or physical defects that would be aggravated by my participation. I will inform my coach if this status changes. I further acknowledge that the risks may involve loss or damage to me or my property, including the risk of death, or other unforeseen consequences, including those which may be due to the unavailability of immediate emergency medical care. I have a current medical consent form in force. I will wear shin guards, properly fitted and appropriate shoes, and other protective equipment (e.g mouth-pieces) as provided by soccer rules, to all events. Beltsville Soccer Academy does not have personal injury insurance that covers my participation. Therefore, I should have a current, active, personal injury insurance policy in force which covers my participation. Under any condition, I am responsible for any and all medical expenses arising from my participation, both in practices and games and while traveling to and from these events. I have the right and responsibility to inspect the equipment and facilities prior to event's end, and if I believe that anything maybe unsafe, I will advise the coach or supervisor of the condition and may refuse to participate. Participation assumes consent. I authorize my photograph, picture, or likeness and voice to appear in any documentary, promotion (including advertising), television, video and radio coverage of the league and tournament, without compensation. I hereby release, waive liability, discharge and hold harmless, indemnify, and covenant not to sue, Beltsville Soccer Academy, Inc, the league and tournament, their associated directors, administrators, officers, managers, employees, coaches, trainers, volunteers, sponsors, advertisers, and other agents, estates or executors, from any and all liability incurred in the conduct of, and my participation in, their soccer programs. I have fully read this agreement and fully understand its contents. I acknowledge that I have given up substantial rights by accepting this document and that I do so voluntarily.

I understand and agree to the terms