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Seascoast United Azzurri Premier Soccer & Futsal

Club Liability Waiver

 

Today's Date: January 15, 2019

1) I, parent/guardian of the minor(s), do hereby consent to my child's participation in the voluntary athletic and/or recreation programs of the Seascoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal,Seacoast United. I also agree to forever release Seascoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal,Seacoast United the facility owners, the towns/city's Public Buildings, and all their employees, agents, board members, volunteers and any and all individuals and organizations assisting or participating in voluntary athletic or recreation programs of Seascoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal,Seacoast United ("the Releases") from any and all claims, rights of action and cause of action that may have arisen in the past, or may arise in the future, directly or indirectly, from personal injuries to my child or property damage resulting from my child's participation in the Seascoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal,Seacoast United Club/Camp/Clinic or anyone doing business with Seascoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal,Seacoast United.


2) I also voluntarily promise, to forever release, indemnify, defend and hold harmless the Releases against any and all legal claims and proceedings of any description that may have been asserted in the past, or may be asserted in the future, directly or indirectly, arising from personal injures to my child or property damage resulting from my child's participation in the Seascoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal,Seacoast United Club/Camp/Clinic program a voluntary athletic and/or recreation program.


3) Should Seascoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal,Seacoast Unitedi or anyone acting on their behalf be required to incur attorney fees and cost to reinforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.


4) I certify that I have adequate insurance to cover any damage or injury I may cause or suffer while participating in these program(s) or else I agree to bear the cost of suchdamage or injurymyself. I further certify that I have no physical or medical condition which could interfere with my safety in this activity or else I am willing to assume - andbear the cost of - all risksthat may be created, directly or indirectly, by an such condition.


5) I further affirm that I have read this Consent and Release From and that I understand the content of this Form. I understand that my child's participation in these programs is voluntary and that my child and I are free to choose not to participate in said program.  I understand that I am responsible for paying for any and all programs, in which I register and that there are no refunds.

6) I have decided to allow my child to participate in the Seascoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal,Seacoast United Club/Camp/Clinic with full knowledge that the Releases will not be liable to anyone for personal injuries and property damage my child or I may suffer in voluntary participation of a F.C. Boston Azzurri or Eastern Mass Soccer Academy Club/Camp/Clinic.  

7) Myself and my child agree to follow the rules of the faciltiy, Seascoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal,Seacoast United and thier staff. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this program,I may be found by a court of law to have waived my right to maintain a law suit against Seascoast - Boston Azzurri, F.C. Boston Azzurri, East Coast Futsal, Seacoast United any facilities or staff involvedon the basis of any claim from which I have released them herein.

8) I understand that there are no refunds when registering for a program.​

By signing this form, I affirm that I have had sufficient opportunity toread this entire document. I have read and I understand it and I agree to be bound by its terms.

January 15, 2019

Please select who will be participating...
AdultMinor
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First Players Name

First Name*

Middle Name

Last Name*

Phone*
First Players Date of Birth*
I certify that I am 18 years of age or older
First Players Information

Health Issues

Health Insurance Co. *

Health Insurance Phone # *

Health Insurance Policy # *
First Players Signature*
Players Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Health Issues

Health Insurance Co. *

Health Insurance Phone # *

Health Insurance Policy # *
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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