| TRI-STATE SOCCER ACADEMY YOUTH LEAGUE Winter 2007 Name________________________________________________________ Age_____ Sex_____ Birth Date_____/_____/_____ Address_____________________________ City_____________________ State_______ Zip__________ Parent(s) Name_______________________________ Home Phone_________________________________ Work Phone_________________________________ Shirt Size: Y-Medium (10-12) Y-Large (14-16) AS AM AL AXL *Checks should be made out to: Tri-State Soccer Academy AND SENT TO: 603 Village Green Drive, Angola, Indiana 46703 -----------------------------OFFICE USE---------------------------------- Team #__________Team Color____________ Coach__________________________________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- RELEASE AND PARENTS’ COVENANT NOT TO SUE Know all men by these presents: That I/We, _________________________________ and _________________________________, in the State of Indiana, Parent(s) of _________________________________, in consideration of the opportunity to participate in the sport of soccer, which is hereby acknowledged, do hereby covenant with the Tri-State Soccer Academy, it assigns or successors, that I/We will never sue or bring any legal action or proceedings against said League; its officers and officials, or their legal representatives or successors, for or on account of any kind of injury or damages we may have sustained by virtue of or claim or demand we have against said League of any nature arising out of said sport, and these presents may be pleaded as a complete or taken by us, our heirs, or legal representatives against the Tri- State Soccer Academy, its assignees, successors, employees, agents, officials, coaches or representatives of any kind or type whatsoever, in breach of this covenant, reserving unto us the right to proceed against any and all other parties involved for the recovery of full satisfaction of any claim for damage which we may have arising out of the said participation in said sport. I/We, hereby agree to indemnify and save harmless the said Tri-State Soccer Academy against claim for damages, compensation or otherwise on the part of said minor child. This covenant not to sue is executed by us in satisfaction of any damage sustained or to be sustained in the future, and is in full satisfaction of any claim for damages. It is distinctly understood and agreed that the acceptance of this covenant not to sue, is not an admission of any liability on the part of the parties herein. This is the joint and several obligations for the parties hereto. In witness hereof, I/We have here unto set our hand seals this __________ day of ____________________, 20_____. ____________________________________ (Parent) ____________________________________ (Parent) Signed, sealed and delivered in the presence of: ________________________________ |
| TRI-STATE SOCCER ACADEMY "Developing the creative player" |
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