Loading...

EAST COAST FUTSAL CLUB

Program Waiver

 

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 East Coast Futsal Club (aka ECFC or EC Futsal Club. I also agree to forever release ECFC, or any Club ECFC may be working with, 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 ECFC, ("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 Seacoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal will establish and if Seacoast - Azzurri, F.C. Boston Azzurri, Club/Camp/Clinic or anyone doing business with ECFC.

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 injuries to my child or property damage resulting from my child's participation in the Seacoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal will establish and if Seacoast - Azzurri, F.C. Boston Azzurri, Club/Camp/Clinic program a voluntary athletic and/or recreation program.

3) Should Seacoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal will establish and if Seacoast - Azzurri, F.C. Boston Azzurri, or anyone acting on their behalf is 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 such damages or injury, myself. 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 -and bear the cost of - all risks that may be created, directly or indirectly, by such condition.

5) I further affirm that I have read this Consent and Release Form 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. 

6) I understand that I am responsible for registering and paying for all programs online and in advance.  If Seacoast - Azzurri, F.C. Boston Azzurri, Seacoast United or East Coast Futsal has to invoice and register my child I understand there is a $25 service fee.  I also understand that I am responsible for full payment for any and all programs, in which I register, or in which my child attends.  I understand that there is no negotiating advertised program costs, after having attended a session or program.   I understand that any "free", "trial", "open house" or free "try out" sessions must be clearly established in writing by Seacoast - Azzurri, F.C. Boston Azzurri or East Coast Futsal.  I understand that there are no refunds.  Seacoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal will, however, make every reasonable effort to accommodate with other sessions under circumstances that Seacoast - Azzurri, F.C. Boston Azzurri, East Coast Futsal will establish and if Seacoast - Azzurri, F.C. Boston Azzurri deems reasonable and possible. I understand that there are no refunds when registering for a program.

7) I have decided to allow my child to participate in the ECFC, 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 involuntary participation of an ECFC, Club/Camp/Clinic.  

8) I and my child agree to follow the rules of the facility, ECFC, and their 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 lawsuit against ECFC, any facilities or staff involved on the basis of any claim from which I have released them herein.

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

June 16, 2019

Please select who will be participating...
AdultMinor
Continue
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 # *

If applicable Team Name and coaches full name
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 # *

If applicable Team Name and coaches full name
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver