SAINTS FA

Players Full Name

Players Date of Birth

Players Skill Level

Parents/ Guardian Full Name

Phone/ Cell Phone Number

Address

City, State, Zip Code

Email Address

In case of Emergency please contact;

Recreational (local) / competitive (travel)

User Agreement

In signing below, I hereby consent to the above-named member organization/club registering me or my child or guardian, as applicable, with US Club

Soccer. I understand that a player may be registered to only one US Club Soccer member organization/club at any time.

Medical Treatment Authorization and Liability Waiver/Release: I hereby give my consent, on my own behalf or on behalf of my child or guardian, as

applicable, to have an athletic trainer, coach, team manager, emergency parent medical technician, physician, nurse, dentist, or other healthcare professional and,

in each case, their associated personnel provide the player identified above with medical assistance and/or treatment and agree to be financially responsible

for the cost of such assistance and/or treatment. I understand treatment for injury will be based, at least in party, on info rmation provided herein. I hereby

authorize emergency transportation of the player, at player or parent/guardian’s expense, to a healthcare facility should an individual listed above consider it

to be warranted. I acknowledge and understand that certain risks of injury (including, but not limited to, concussions, other serious bodily injury or death) are

inherent in playing soccer. These types of injuries may result from the player’s actions, the actions or inactions of others, or a combination of both. In signing

below, I certify that the player received all necessary medical clearances to participate fully in all US Club Soccer programs without restriction or condition.

To the maximum extent permitted by law, I hereby agree to release, waive, hold harmless and indemnify the member organization, the National

Association of Competitive Soccer Clubs (dba US Club Soccer), its agents, contractors and sponsors, U.S. Soccer and its affiliated organizations,

and the employees and associated personnel of these organizations, against any claim by or on behalf of the player named above as a result of

the player’s participation in US Club Soccer programs and/or being transported to or from the same, which transportation I hereby authorize.

Privacy Policy & Terms of Use: I acknowledge and agree that I have read, understand and agree to US Club Soccer’s Privacy Policy & Terms of Use

(collectively, the “Policy”), available at usclubsoccer.org. The Policy describes US Club Soccer practices for collecting, maintaining, protecting and disclosing

player information. In signing below, you agree on your own behalf or on behalf of your child or guardian, as applicable, to the provisions of the Policy.

AGREED AND ACCEPTED: I hereby agree and accept all terms and conditions set forth in this Player Information, Medical Treatment Authorization,

Liability Waiver/Release, and Consent Form.

Parent/Guardian Signature