Registration for Lil Kraze/Lil Krush SoccerAcademy

Friday, March 12, 2010

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Registration for Lil Kraze/Lil Krush Soccer Academy

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**Note: each child must have their own registration, however, payment may be combined at checkout.**

Gender MaleFemale	Birthdate (Month, Date, Year)
First Name	Last Name
Street Address	City
State	Zip
Home Phone #	Mobile Phone #
Parent's First Name (if under 18)	Parent's Last Name (if under 18)
Email Address 1*	Email Address 2
Medical Condition* ExcellentOther	If other, you must provide physician's release prior to joining
Shirt Size

Name of Person Responsible for Payment
By checking this Release of Liability form: I agree to the following on behalf of myself, MY CHILDREN, my executors, administrators, heirs, next of kin successors and assigns and also recognize that playing soccer in any capacity (try-out’s, practice, camps, sports performance sessions, tournaments) is a vigorous, physically demanding sport and any player could suffer serious injury or even death. I hereby agree to waive, release and discharge from any and all claims or liabilities for death or personal injury or damages of any kind, which arise out of or relate to my participation in, or my traveling to and from any event. The following persons or entities: Team Owners, Members, Volunteers, Coaches, Players, Sponsors, Officers, Directors, Employees, Representatives, Agents, or anyone in the Kraze, Krush, Academy, Pee Wee and FC United LLC. I have inspected the facilities and equipment and accept the condition and facilities. I hereby agree not to sue any of the persons or entities mentioned above for any of the claims or liabilities I have waived release or discharged herein. I hereby agree to indemnify and hold harmless the person or entities mentioned above from any claims made or liabilities assessed against them as a results of my actions. I HEREBY AGREE THAT THE ABOVE INFORMATION ON THE SET FORTH ABOVE IS TRUE AND CORRECT. I HEREBY AFFIRM THAT I AM EIGHTEEN (18) YEARS OF AGE OR OLDER, I HAVE READ THIS DOCUMENT AND I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY AGREEING TO THIS VOLUNTARILY.

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