Registration

Player Information

Player's Full Name

Birthdate

Email

Gender

Address

Street

Street 2

City

State

Zip Code

School

Grade

School

Parents/Guardians

Parent/Guardian 1 Name

Phone

Email

Parent/Guardian 2 Name

Phone

Email

Parents/Guardian's Address (if different than above)

Parents/Guardian's Employer (name/address/phone)

Emergency Contact

Person 1 Name

Phone

Relationship

Person 2 Name

Phone

Relationship

Medical

Family Doctor

Address

Phone

Insurance Carrier

Policy Number

Date of Tetanus Booster

Known allergies, including allergies to medicine

Any other medical problems

Person responsible for charges (if different than above)

Address

Phone

Email

Birth Certificate

Upload Player's Birth Certificate (optional)

Photo ID

Upload Photo ID (optional)

More Information

Language(s) spoken at home

Country of Birth

Is your child currently on a soccer team?

If yes, what position does he/she play?

If no, has he/she played on a soccer team before?

If yes, for what club/team did he/she play?

Child's shirt size

Preferred Location

Would you like to volunteer for ANSA?

Release of Liability For Minor Participants

In consideration for the permission granted to me/or my minor child/ward, (“”), to participate in activities associated with ALL NATIONS SPORTS’ program or related events and activities, the Undersigned acknowledges, appreciates, and agrees to the following:

  1. The risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist. FOR MYSELF, SPOUSE AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation.
  2. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
  3. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE ALL NATIONS SPORTS, its officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABLILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
  4. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.
  5. I, for myself, my spouse, my child, give permission for ALL NATIONS SPORTS Soccer academy to photograph and video activities that include my child. These photographs and video will only be used to promote programs and events for ALL NATIONS SPORTS on our websites and other media outlets.
  6. I give my permission for my child to be transported by ALL NATIONS SPORTS in adult-driven vehicles (parents, employees and volunteers).
  7. I agree on behalf of myself and my child not to damage or destroy the soccer field, its equipment and related facilities. In the event that the soccer field, its equipment and related facilities are damaged or destroyed, I agree to pay reasonable and necessary repair costs for such damages.
  8. I affirm that I am eighteen (18) years of age or older. I am the parent or legal guardian for my child for whom I sign this Voluntary Waiver and Release of Liability and Indemnity Agreement and I have authority to sign on behalf of my child.
  9. I request that in my absence the above player be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have not been given a guarantee as to the results of examination or treatment. I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the above-named player.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

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