Author: Jennifer Osborn

United States Adult Soccer Association
A National Association Member of the United States Soccer Federation
North Coast Soccer League 2021-22
Adult Amateur Player Registration Form

INSTRUCTIONS: Player and team manager PRINT the information on form and pass card. Player and manager must sign and date the form at the bottom of the page.

Male

Female

Player’s Last Name

Player’s First Name

Player’s ID Number

Player’s Mailing Address

City

Player’s Phone Number

State

Zip Code

Email Address

Date of Birth

Country of Birth

Team Name

Mo. Day Yr.

Photo goes
here

League Name

Manager Name

Release and Disclaimer
Soccer is a contact sport involving risk of serious injury, disability or death. Not all risks are foreseeable. In consideration of being allowed to participate, I agree to release, waive and covenant not to sue United States Soccer Federation or affiliates on account of injury, death or property damage alleged to be caused in whole or in part by affiliates’ actions or omissions.
I HAVE READ THE RELEASE & DISCLAIMER AND RECOGNIZED THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING. I KNOWINGLY ASSUME THE RISK.
Player’s Signature Date
Team Manager Signature Date
State Registrar Date

Player pass to be detached by league registrar only

United States Adult Soccer Association Player Pass
Association Name 2021-22

ID#

Amateur

Pro

Player’s Last Name First
Birthdate
Division League
Team
Player’s Signature

Mo. Day Yr.

Photo

League Registrar Approval
Date pass issued

ASSUMPTION AND ACKNOWLEDGMENT OF RISKS AND RELEASE OF LIABILITY AGREEMENT
In consideration of being allowed to participate in any way for the United States Adult Soccer Association, Inc., Its Affiliates, Leagues, and Member Teams, its related events and activities, the undersigned, acknowledges, appreciates, and agrees that:
The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
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 participation; and,
I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will bring such to the attention of the nearest official immediately; and
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS the United States Adult Soccer Association, Inc. Its Affiliates, Leagues and Member Teams, their 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, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
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.
X___________________________________________ Age: ________Date Signed: ________________ PARTICIPANT’S SIGNATURE
FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES to the fullest extent permitted by law.
X________________________________ ___________________________________
PARENT/GUARDIAN’S SIGNATURE EMERGENCY PHONE
Date Signed: _________________________