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Fall Season 2024 Players Form

PLAYER INFORMATION

PARENT/GUARDIAN
Please Upload Birth Certificate Here:

https://driveuploader.com/upload/bEcykUXHAI/

MEDICAL/EMERGENCY CONTACT INFORMATION


WAIVER INFORMATION

​WAIVER INFORMATION
CONSENT FOR MEDICAL TREATMENT (MINOR)
As the parent or legal guardian of the above-named player, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of my dependent.
IMPORTANT
I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the LSSA, its affiliated organizations, and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the LSSA accepting the registrant for its soccer programs and activities (the Programs). I hereby release, discharge, and/or otherwise indemnify the LSSA, 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 LSSA Parties 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.

COMMUNICABLE DISEASE
RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
In consideration of being allowed to participate in any way in the program, related events, and activities, I
the undersigned, acknowledge, appreciate, and agree that:
I am aware there are risks to me of exposure directly or indirectly arising out of, contributed to, by, or
resulting from an outbreak of any and all communicable diseases, including but not limited to, the virus
?severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)?, which is responsible for Coronavirus
Disease (COVID-19) and/or any mutation or variation thereof.
I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY
RELEASE, INDEMNIFY, AND HOLD HARMLESS North Texas State Soccer Association, Inc. and its
Member Associations, Clubs, and Leagues, as well as their respective officers, officials, agents and/or
employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises
used to conduct the event (RELEASEES), from any and all claims, demands, losses, and liability arising
out of or related to any ILLNESS, INJURY, DISABILITY OR DEATH I may suffer, WHETHER ARISING
FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY
SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF
REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree
to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of
kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents
to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING
FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.
 

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