United States Adult Soccer Association, Inc.

A Member of the United States Soccer Federation

9152 Kent Ave. Suite C-50, Lawrence, IN  46216,  Tel: 317-541-8554, Fax: 317-541-8568

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 |                   MICHIGAN SOCCER ASSOCIATION

  Code                              State Association

| 0| 4 |                    GREAT LAKES WOMEN’S SOCCER LEAGUE

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!