Player Registration - Romanian Soccer Festival

(Las Vegas, NV Oct. 6 & 7, 2007)

(please print firmly and legibly to make clear multiple copies)

Team Name: ______________________          Team Captain/Coach: ________________________

Last Name: __________________     First Name: ________________     DOB: ___/___/_______    

Age: _____     Sex:  M / F     Address: _______________________________________________    

City: _________________     State: _____     Zip: ___________

Telephone: _____-_____-_______       E-mail: __________________________

List any medical problems and/or prohibitions:

__________________________________________________________________

__________________________________________________________________

Doctor to notify in case of emergency: ________________________     Phone: ____-____-_____

Person to notify in case of emergency: ________________________    Phone: ____-____-_____

Adult T-shirt Size (circle one):  XS  S  M  L         Indoor/Outdoor soccer experience:  Y /  N

Emergency Medical Release & Liability Waiver

 I, the undersigned, (if applicant/participant is 18 years of age or older or parent/guardian of the above listed minor applicant/participant) acknowledge and fully understand that each applicant/participant will be engaging in activities that involve risk of serious injury, including permanent disability or death, and severe social and economic losses which might result not only from their own actions, inactions or negligence, but action, inaction or negligence of others, the rules of play, or the condition of the premises or of any equipment used and further, that there may be other unknown risks not reasonably foreseeable at this time, assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death, hereby release, discharge, covenants to indemnify and not to sue Delta Soccer Tournament, its affiliated organizations and sponsors, their coaches, managers, employees and associated personnel, officers, directors, agents, including the owners and leasers of premises used to conduct the event, all of which are hereinafter referred to as ‘releasees’, from any and all liability to each of the undersigned, his/her heirs or next of kin for any and all against any claim by or on behalf of the applicant as a result of the applicant’s participation in the Program and/or being transported to or from the same, which participation, after careful consideration I hereby authorize, and which transportation I hereby authorize. I hereby give my consent to have an athletic trainer, coach and/or doctor of medicine or dentistry or associated personnel to provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I, also agree save and hold harmless and indemnify each and all parties herein referred to above as releasee from all liability, loss, cost, claim or damage whatsoever, including death or damage to property, which may be imposed upon said releasee because of any defect in or lack of such capacity to so act or caused or alleged to be caused in whole or in part by the negligence of the release. I have read the above waiver/release and understand that (I) we have given up substantial rights by signing this release and sign below voluntarily. I will also abide by the rules of the Program.

NAME: ___________________________     SIGNATURE: _____________________   DATE: ________________

(please print)                                                                                   (Parent/Legal Guardian )