Mar. May 11th, 2021

WB SOCCER ACADEMY

Soccer Excellence WBSA

WBSA Supplemental Training

WBSA Spring Season 2021

WBSA 2021

Player Name:   __________________________________   Team Name:  _____________________

Address:          ________________________________________________________________________

Home#:                       __________________________   Cell#:  _____________________ DOB:  ___________

Emergency Contact Person:  _____________________   Phone#:  _______________________________

E-Mail:  _______________________________ circle sport:  Soccer      t-ball

 

I hereby give my full consent and approval for participating as a team member in the sport or activity designated above.

I understand that there are certain risks of injury inherent in the practice and play of this sport or activity, as well as in traveling and other related activities incidental to my participation, and I am willing to assume these risks.  I hereby certify that I’m fully capable of participating in the designated sport or activity and that I am healthy and have no physical or mental disabilities or infirmities that would restrict full participation in these activities, except as listed below.

In addition of giving my full consent for my kid participation, I do hereby waive, release and hold harmless WBSA and   its officers, coaches, sponsors, supervisors and representatives for any injury that my kid  may be suffered  in the designated sport or activity and the activities incidental thereto, whether the result of negligence or any other cause.

Please list any physical limitations (allergies, hearing, sight, etc.)

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________.

 

Signature:  _______________________________________

(Parent if under 18 yrs. Of age)

Date:  ___________________                                                                                                                                            WBSA 2021