Registration and Release

MANDATORY ACADEMY REGISTRATION & RELEASE FORM

Player’s Name_____________________________ DOB_____________

Parents’ Names_____________________________________________

Team__________________________Coach_________________________

Address _________________________City ___________ Zip __________
Ph #______________________________Alt # _______________________

EMail_________________________________________________________

I, as Parent/Guardian, authorize any first aid or emergency medical care that may become necessary for my child/ward while he/she is participating in the "Training Session". In consideration of the acceptance of my child/ward's entry into the session, I, my heirs, executors, administrators and personal representatives hereby discharge, waive and release Riverplate Soccer Club, Soccer Studio, Juan Sastoque, Josema Bazan, partners, sponsors, coaches, agents, employees, and facility owners from any Liability, Claims, Damages or Lawsuits resulting from Personal or Physical injury to my child/ward.

I certify that my child is not a member of a North-Texas State Soccer Association. I am aware that if my child is a member of a NTSSA, I am required to have the coach of that team read and sign the non-recruiting statement below to be able to participate in any of Riverplate or Soccer Studio event.

I have read and understand the above-mentioned disclaimer and medical release.

Parent Signature Date

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