*BELPRE FIREBALLS TRAVEL TEAM*

PLAYER INFORMATION
This box must be checked for form to be accepted. By checking this box I the parent/guardian of the registrant, a minor, or adult registrant of legal age, agree that I and the registrant abide by the rules of the Belpre Soccer Club, its affiliated organization and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the BSC accepting the registrant for soccer programs and activities, I hereby release, discharge and/or otherwise indemnify the BSC, its affiliated organizations, their employees and associated personnel, including owners of the fields and facilities utilized for the programs against any claim by or on behalf of the registrants participation in the program and/or being transported to or from the same, which transportation I hereby authorize.

* required


Payments Accepted By

Note: Credit Card information can be entered once this form is submitted