Macomb Adult Soccer

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2019 Spring Open Division I - 18+ Registration Form

* Todays Date:

PLAYER INFORMATION

* First Name:

* Last Name:

* Street:

* City:

State:

* Cell Phone:

Home Phone:

* Birthdate:

* Email:

* Gender:

* Payment Type:

Check No.:

* School you are attending:

* New Player or Returning Player for 2018:

* Team Name:

I want to be on the same team as my friend:

* Shirt Size:

* Specific or Random Jersey Number:

Jersey Number:

* Full time Player or Sub:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

Relationship to Player:

Insurance Carrier:

WAIVER, RELEASE AND INDEMNITY

In consideration of being allowed to participate in the Macomb Adult Soccer (MAS), Amateur League (AAL), and related events and activities, which I have voluntarily, willingly and knowingly elected to do, the undersigned:

1. Acknowledges and represents that he or she understands the nature of soccer, specifically that it is a contact sport with a risk of injury, and that he or she is qualified, in good health, and physically able to participate.

2. Agrees that, prior to participating, her or she has been afforded the opportunity to inspect the fields, facilities and equipment to be used and if he or she believes anything to be unsafe, he or she will immediately advise his or her captain or representative of such condition and refuse to participate.

3. Acknowledges and fully understands that by participating he or she will be engaging in activities that involve the risk of injury, including permanent disability and death, and severe social and economic losses which might result not only from his or her own action, inaction or negligence of others, the rules of play, or the conditions of the premises or of any equipment used, and that there may be other risks not known or not reasonably foreseeable at this time.

4. The undersigned hereby assumes full responsibility for and risk of bodily injury, death or property damage while upon Township property or participating in the activity or using any facilities and equipment whether caused by any negligent act or omission of releases or otherwise.

5. The undersigned hereby releases, waives, discharges and covenants not to sue Washington Township, Macomb Adult Soccer it's employees, officers and agents (herein referred to as "releases") from all liability to the undersigned his or her personal representatives, assigns, heirs, and next of kin for any loss, damage, or claim therefore on account of injury to the person or property of the undersigned whether caused by any negligent act or omission of the releases or otherwise while the undersigned is participating in the Township activity or using any facility in connection with the activity.

6. The undersigned hereby agrees to indemnify and hold harmless the releases from all liability, claims, demands, causes of action, charges, expenses, and attorney fees (including attorney fees to establish the release’s right to indemnify or incurred on appeal) resulting from involvement in this activity whether caused by any negligent act or omission of the releases or otherwise.

I acknowledge that I have read the foregoing and that I am aware of the legal consequences of this agreement, including that it prevents me from suing the Macomb Adult Soccer, Township or its employees, agents, or officers if
I am injured or damaged for any reason as a result of participation in this activity. I further acknowledge that no oral representations; statements or inducements have been made.

I agree with the above, have read and will follow all league rules *

* indicates required fields

Club Car Sticker($3)

XL Size($2)

2XL Size($3)

3XL Size($4)

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2019 Spring Open Division I - 18+ Registration Form