Royse City Soccer Association - (Royse City, TX)

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RCSA KEEPER CAMP

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

* State:

* Zip Code:

* Birthdate:

* Gender:

PARENT/GUARDIAN

* First Name:

* Last Name:

* Email:

* Phone #1:

* Phone #2:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

Relationship to Player:

WAIVER INFORMATION

I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the USYS and RCSA, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the USYS and RCSA accepting the registrant for its soccer programs and activities (the Programs). I hereby release, discharge and/or otherwise indemnify the USYS, its affiliated organizations and sponsors, their employees and associated personnel, including the registrant as a result of the registrant, participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. I further grant the USYS Parties and RCSA the right to use the player's name, pictures and/or likeness in printed, broadcast and other material concerning the Programs provided such use is related to the player's status as a participant in the Programs. As the parent or legal guardian of the above-named player, I here by give consent to have an Athletic Trainer and/or Doctor of Medicine or Dentistry to provide medical assistance and/or treatment and agree to be responsible financially for the reasonable cost of such assistance and/or treatment. This care may be given under whatever conditions are necessary to preserve the life, limb or well-being of my dependent.

I/we agree with the above *

* indicates required fields