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Tampa Soccer & Futsal Academy

FULL name of participant: Last :_______________First____________________(M) _______
 
Address:________________________ City__________Zip code:________
 
Phones: Home __________________Work _________________
 
Cell__________________Emergency___________________
 
E-mail:______________________________________
 
Emergency contact: Last_____________________First_______________ Relationship: __________
 
MALE-FEMALE
 
How many years of experience in this sport?___________
 
TASFACA PROGRAM: ________________Starts________End_________ at :___________________
 
The undersigned adult ( 17 plus ) request to participate in the above program.
In consideration of the permission granted, THE UNDERSIGNED adult for him/her self, his/her heirs family members, executors, administrators and personal representatives, herby release, waive, discharge and convent NOT to sue the TASFACA , its Board of Directors or the PROPERTY OWNER where this activity is held ( all for purposes herein referred to as ' releases ") from all liabilities, claims, actions, damages, costs or expenses which all of the undersigned, their heirs, family members, executors, administrators and personal representatives may have against any of the releasers arising out of or in any way connected to the undersigned minor's participation including travel to or from participation in the activity, bodily injury, death or property damage suffered by the undersigned minor before, during or after any participation. All of the undersigned understand that the release and waiver includes any claim or action based on the negligence, action or inaction of any releasers, or otherwise.
ALL OF THE UNDERSIGNED ASSUME FULL RESPONSIBILITY FOR RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE.
Due to the negligence of releasers or otherwise while competing, observing, or participating in any other way in the activity. ALL OF THE UNDERSIGNED expressly acknowledge and agree that the aforesaid activity may involve the risk of injury and/or death or property damage.
ALL OF THE UNDERSIGNED shall defend the, hold harmless and indemnify the organization, its officers, employees and agents, from and against all liability, loss, claims, damages, costs, attorneys' fees and expenses of whatever kind or nature which the organization, its officers, employees and agents may sustain, suffer, or incur or be required to pay by reason of participating in the program.
ALL OF THE UNDERSIGNED further expressly agree the forgoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the laws of the State of Florida or other State where a claim of action may be instituted and that if any portion thereof is held invalid. , It is agreed that the balance shall notwithstanding, continue in full legal force and effect.
I, the undersigned have proved by showing my: (document) Birth Cert./Driver lic.___________to be older than 17 years.
I, the undersigned, have read this instrument and understand all its terms.
I, execute it voluntarily and with full knowledge of its significance.
In witness whereof, I have executed this instrument at (Place of execution)______________________________
 
 
 
Print Name:___________________This_____day    of ________20____  
 
 Signature________________
 
 
 
This instrument is notarized by:
 
 
( Name of Notary): _______________________________
 
 
 
Seal expired on: ______
 
 
 
 
Seal__________________________________date:________________

SOCCER TRAVEL and Tournaments