United States Adult Soccer
Association, Inc.
A Member
of the
usasawalker@aol.com
AMATEUR PLAYER REGISTRATION FORM
This
form may not be used for the registration of a professional player! Please
complete all of the information, including the date and your signature in the
bottom segment of this form. Please use
ballpoint pen and print legibly
PLAYER’S
INFORMATION
Last Name First
Name Middle
Initial Male/Female Player’s
Registration No.
Street Address City Zip
Code
Home Phone Bus. Phone e-mail
address
TEAM INFORMATION
| 2 | 6
|
Code State
Association
| 0| 4 | GREAT
League No. League Name
Team No. Team Name
Team
Manager’s Name Team
Manager’s Street Address City Zip Code
Team Manager’s Home Phone Bus.
Phone e-mail
address
RELEASE AND DISCLAIMER
I understand that Soccer is
a contact sport involving risk of serious injury, disability, or death, and
that not all risks are foreseeable. In
consideration of being allowed to participate, I agree to release, waive, and
covenant not to sue the 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 RECOGNIZE THAT I GIVE UP SUBSTANTIAL RIGHTS BY
SIGNING. I KNOWINGLY ASSUME THE RISKS.
Player’s Signature:_________________________________________ Date: ________________
Team Representative’s Signature:_____________________________ Date: ________________
State Registrar’s Signature___________________________________ Date ________________
Return
this form to your Team Manager.
An Individual Registration Form MUST be on file with
the GLWSL Registrar for ALL players listed on the Team Roster Form PRIOR
to their play in ANY GLWSL league game!