2016 Free Soccer Tryout Registration

PLAYER INFORMATION
This form allows one player to register for upcoming try outs

To help you determine what age group your child will play in the fall, we have included the birth year (BY) but as always your child may play up if you wish

PARENT/GUARDIAN #1

PARENT/GUARDIAN #2

MEDICAL/EMERGENCY CONTACT INFORMATION

WAIVER INFORMATION
This child has my permission to try out for Runnin Rebels FC.

As Parent/Guardian of a participant in this program, I recognize and acknowledge that there are certain risks of physical injury. I/We assume the full risk of any injuries, including death, damages, or loss which I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with such program.

I agree to waive and relinquish all claims I or my minor child/ward may have as a result of participating in the program against the Runnin Rebels FC, and their officers, agents, and employees. I do hereby fully release and discharge the Runnin Rebels FC, and their officers, agents, and employees from any and all claims from injuries, including death, damage, or loss which I or my minor child/ward may have or which may accrue to me or my child/ward on account of our participation in the program.

I further agree and indemnify and hold harmless and defend the Runnin Rebels FC, and their officers, agents, servants, and employees from any and all claims resulting from injuries, including death, damages, and losses sustained by me or my child/ward and arising out of, connected with, or in any way associated with the activities of the program.

Runnin Rebels FC do not carry medical or accident insurance for participants. We suggest you look at your own insurance policy to be sure you and your child/ward are adequately covered. Runnin Rebels FC assume no responsibility for personal injuries or loss of property.

As Parent/Guardian of a participant in this program, I recognize and acknowledge that there are certain risks of physical injury. I/We assume the full risk of any injuries, including death, damages, or loss which I or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with such program.

I agree to waive and relinquish all claims I or my minor child/ward may have as a result of participating in the program against Runnin Rebels FC, and their officers, agents, and employees. I do hereby fully release and discharge Runnin Rebels FC, and their officers, agents, and employees from any and all claims from injuries, including death, damage, or loss which I or my minor child/ward may have or which may accrue to me or my child/ward on account of our participation in the program.
I am aware that pictures/video of my child(ren) may be taken during the season. I am aware that pictures may be posted to the website. The pictures/video will be used solely for the purposes of illustrating games through out the season. Pictures posted to the website are considered to be property of Runnin Rebels FC and may not be sold or reused without the express consent of the Runnin Rebels FC. Parents who have special concerns or requirements regarding photography of their children agree to contact Runnin Rebels FC board members in advance of the soccer season to resolve any outstanding issues regarding the use of their child(ren's) photographs/videos.

I further agree and indemnify and hold harmless and defend Runnin Rebels FC, and their officers, agents, servants, and employees from any and all claims resulting from injuries, including death, damages, and losses sustained by me or my child/ward and arising out of, connected with, or in any way associated with the activities of the program.

In case of emergency, if our family physician can not be reached, I authorize my child/ward named above to be treated by another physician or the Bolingbrook paramedics.

 

* indicates required fields


Payments Accepted By

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