High School Boys ID - FC Wichita

INFORMATION REQUEST

PLAYER / GUARDIAN INFORMATION

Player Name

Player Birth Date

(i.e. mm/dd/year)

Player Gender

Male Female

Player Graduation Year

Enter the players high school graduation class.

Previous Team

What team did you play for last season?

Legal Guardian Information

Legal Guardian Name

Legal Guardian Email

Legal Guardian Phone

Legal Guardian Address

Street Address

City

Country

WAIVER OF LIABILITY

PARENT/LEGAL GUARDIAN MUST ACKNOWLEDGE EACH SECTION FOR YOUR CHILD TO PARTICIPATE

Playing Waiver & Release of Liability

I hereby take the following action on behalf of my minor child, myself, my executors, administrators, successors and assigns:

a) I 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 child’s participation in, or my child’s traveling to and from the soccer event, THE FOLLOWING PERSONS OR ENTITIES: FC Wichita; Wichita Sports LLC; and any sponsors and facilities obtained by the Club; any Players, Coaches, Officers, Directors, Employees, Representatives, or Agents of the above.

b) I AGREE NOT TO SUE nor bring any type of lawsuit against any persons or entities mentioned above for any of the claims or liabilities that I have waived, released or discharged herein.

c) I INDEMNIFY AND HOLD HARMLESS the persons or entities mentioned above from any claims made or liabilities assessed against them as a result of my actions.

Playing Waiver & Release of Liability

Yes. I hereby acknowledge and agree to the section above.

Playing Waiver & Release of Liability

I acknowledge that sports are an extreme test of a person’s physical and mental capacity and carry the potential risk of serious bodily injury and in some cases death. I understand that my child, the participant, may be asked to compete in games for, practice for, participate in, and travel to and from soccer events on behalf of the

FC Wichita; Wichita Sports LLC, and I HEREBY ASSUME THE RISK OF PARTICIPATION IN THE SOCCER EVENT.

I understand that prior to my child participating, I will inspect the facilities and equipment to be used and if I believe anything is unsafe, I will immediately advise the coach or supervisor of such condition(s) and may refuse to participate. If I choose to participate after inspecting the facilities, I assume the risks listed above.

Playing Waiver & Release of Liability

Yes. I hereby acknowledge and agree to the section above.

MEDICAL RELEASE AND AUTHORIZATIONS

PARENT/LEGAL GUARDIAN MUST ACKNOWLEDGE EACH SECTION FOR YOUR CHILD TO PARTICIPATE

Medical Release and Authorizations

I hereby authorize any licensed physician, emergency medical technician, hospital or other medical or healthcare facility to treat the minor named herein for the purpose of attempting to treat or relieve any injuries received by said minor arising out of or relating to the soccer event. I authorize any such Medical Provider to perform all procedures deemed medically advisable. I realize and appreciate that there is a possibility of complications and unforeseen consequences in any medical treatment, and I assume any such risk for and on behalf of myself and said minor.

Medical Release and Authorizations

Yes. I hereby acknowledge and agree to the section above.

Medical Release and Authorizations

I HEREBY AUTHORIZE the FC Wichita; Wichita Sports LLC, to publish photographs taken of my child and child's name and likeness, for the use in the Club’s print, online, and video-based marketing materials as well as other company publications.

Medical Release and Authorizations

Yes. I hereby acknowledge and agree to the section above.

Medical Release and Authorizations

As the parent and natural guardian or legal guardian. I hereby agree to the foregoing Waiver and Liability Release, Medical Release and Authorizations for and on behalf of the named herein. I hereby bind myself, the minor and all other assigns to the terms of the Waiver and Liability Release. I represent that I have legal capacity and authority to act for and on behalf of the minor in the execution of the waiver and Liability Release.

Legal Guardian Signature

Full Name

Sign

Payment

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Discount

Subtotal

Tax

Total USD