Preferred Hospital:
Medical Insurance Provider:
I, the undersigned parent or legal guardian of the above player(s), all minors, for myself and on behalf of the above player(s), our heirs, assigns the next of kin, acknowledge that participation in soccer necessarily involves travel, play in adverse field conditions, contact with considerable force, and the risk of severe, permanent physical injury including bruises, scrapes, strained, sprained or torn muscles, tendons or ligaments, broken bones, dislocation of joints, concussions, brain damage, nerve and/or spinal cord injury, paralysis and death. For myself, and on behalf of the above player(s), our heirs, assigns and next of kin, we willingly and voluntarily accept and assume all such risks.
For myself and on behalf of the above player(s), I further acknowledge that the American Youth Soccer Organization (AYSO) is primarily administered by volunteers rather than paid professionals. For myself and on behalf of the above player(s), he/she and I willingly and voluntarily agree to comply with the stated and customary terms and conditions for participation and, if he/she or I observe any unusual significant concern in his/her readiness for participation and/or in the program itself, I will remove him/her from participation and bring such concern to the attention of the nearest official immediately and also of the Regional Commissioner as soon as possible thereafter.
In consideration of accepting the registration and permitting the voluntary participation of the above-named participant(s) in its programs, for myself and on behalf of the above player(s), our heirs, assigns and next of kin, I hereby release, discharge and agree to hold harmless AYSO, its employees, volunteers, officials, sponsors and other representatives and any and all owners, lessors, lessees or other persons or entities allowing, permitting and authorizing the use of facilities by AYSO and the agents, employees, officers and directors of said persons or entities from any and all claims, demands, costs, expenses and compensations arising out of or in any way related to any injury or other damage that may result to said participant(s) or to members of my family or my household or individuals I invite or for whom I am otherwise responsible while participating in or present at any AYSO-sponsored event, including any physical or other injury caused by the negligence of any person or entity described above.
Please select from the positions below for which you are willing to serve.
In addition to the AYSO registration fees for my child’s playing level, I agree to pay the following additional fee in lieu of participating in the fund raiser:
I, the parent or legal guardian of the applicant, hereby give my permission for him/her to participate in the soccer activities during the current season. I absolve, indemnify, and hold harmless the Association, coaches, and sponsors or representatives appointed by the Association. I likewise waive, to the extent not covered by the liability insurance, any claim against any person transporting the applicant to and from activities. I will furnish, if requested, a certified birth certificate for the applicant and further certify that he/she is in good health and physically able to participate on a soccer team.