Name of Players:

Number of Players registering

'10-'11 School Grade for Players above:

Mother's Last Name:

Mother's First Name:

Father's Last Name:

Father's First Name:

Email (we will use this to notifiy you of cancellations)

Emergency Contact Name & Number

Have you participated in RSC programs or teams before?

Please share anything else you would like:

Waiver:

By checking the box below, We hereby acknowledge and certify via electronic submission/signature that we are the parents/legal guardians for the player/participant listed herein. We acknowledge and fully understand that the player is engaging in activities that involve risk of injury, including permanent disability or death, and severe social and economic losses. We agree to save and hold harmless, to indemnify and not to sue the Rock Soccer Club, its directors, officers, employees, coaches, managers, agents, sponsors and associated personnel including those of its affiliated organizations, and the owners and lessors of premises used to conduct the event (hereinafter collectively referred to as releasees) from all liability, loss, cost, claim or damage whatsoever, including death or damage to property, caused, or claimed to be caused, and any injury or accident resulting from participation or alleged to be caused in whole or in part by the negligence of the releasees.This waiverand release applies to any and all activities, including arrival and departure from RSC, public or private property.

I/we (above indicated) hereby acknowledge that I/we have reviewed this form and caused it to be electronically executed with the intent to be bound to the terms contained herein.