My Soccer Fitness

&

Liberty F.C.

Registration Form

Name of Player: _____________________________________

Address: ___________________________________________

Email: _____________________________________________

Parent Contact Phone: _______________________________

Player’s DOB: _______________________________________

In the event that I, _______________________, appear in MSF/Liberty F.C. videos/pictures I consent to the use of photographs and video in which I appear, taken during Liberty F.C.. I consent only to the use of these videos/photographs of me by Liberty F.C. for its web and print materials and do not consent to any other commercial use of any image of me.

I understand that the participant named above has made application to be enrolled in MSF/LIBERTY F.C. soccer specific training. The undersigned parent(s) or legal guardian(s) of the participant acknowledge that: I /We understand that there is risk of personal injury associated with the participation of soccer training programs, events and activities, which can result in temporary or permanent disabilities and/or personal loss and economic damages. I/We understand that LIBERTY F.C. provides no pre-enrollment medical examination and takes no responsibility for assessing the health and physical condition of the participant. I/We agree to the following: 

1. I/We consent to the participant enrolling in MSF/LIBERTY F.C. training.

2. I/We will instruct the participant to review and carefully follow all of the MSF/LIBERTY F.C. instructor’s guidelines, rules and procedures for safety.

3. I/We accept and assume full responsibility for consulting with a doctor about the players physical condition and hereby warrant, represent, and state that the participant named above is in good physical condition and that the participant has no disability, impairment, or ailment that would prevent him/her health, safety, comfort or physical condition.

4.  I/We accept and assume all risk and responsibility for accidents, illness, injury, and or damage which may result from the participant participating in any of the events or activities associated with the MSF/LIBERTY F.C. workouts and hereby waive, release and discharge, MSF/LIBERTY F.C., its directors, trainers, and employees from any and all liability thereof. 

I have read the forgoing and understand that its terms include my consent and my agreement to take certain actions, to assume certain responsibilities and to release MSF/LIBERTY F.C. from certain liabilities. I sign it voluntarily with full knowledge of its significance. 

Parent/ Guardian Signature: _____________________________ Date: _____________