Tryout Registration Form

PLAYER INFORMATION

PARENT/GUARDIAN

PARENT/GUARDIAN #2

MEDICAL/EMERGENCY CONTACT INFORMATION

WAIVER INFORMATION
MEDICAL WAIVER:
I hereby release, waive liability, discharge, hold harmless, indemnify, and covenant not to sue, the United States Soccer Federation, the State Association, the SCP Club, the league and tournament, their associated directors, administrators, officers, managers, employees, coaches, trainers, volunteers, sponsors and advertisers, and other agents, estates or executors, from any and all liability incurred in the conduct of, and my participation in, their soccer programs.
This includes owners, lessors, and lessees of premises, municipalities, government agencies, successors, heirs, and assigns.
I have completely read this document and fully understand its contents. I acknowledge that I have given up substantial rights by accepting this document and that I do so voluntarily. My signature attests to this on behalf of myself and my executors, personal representatives, administrators, heirs, next-of-kin, successors, and assigns.
For those individuals under the age of eighteen (18) years (minor):
As the parent and natural guardian or legal guardian of the participant, I hereby agree to the foregoing Waiver of Liability and Release for, and on behalf of, the participant (player/minor) named above. I hereby bind myself, the minor, and all other assigns to the terms of the Waiver of Liability and Release. I represent and certify that I have the legal capacity and the authority to act for, and on behalf of, the minor in the execution of this Waiver of Liability and Release.

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Permission to Use Photograph /Video
I grant to Sport Club Portuguese its representatives and employees the right to take photographs of me and my Family in connection with the above-identified subject. I authorize Sport Club Portuguese, its assigns and transferees to copyright, use and publish the same in print and/or electronically.
I agree that Sport Club Portuguese may use such photographs of my child or me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I have read and understand the above:


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