Strikers-CB U12 Girls Soccer Teams
2 Team System - Tryout Form 2014-2015
See http://www.strikerscb.blogspot.com/ for up-to-date team and tryout information
(This form also available to complete at the field between 4:30-5:30pm, May 28th, 2014)
(This form also available to complete at the field between 4:30-5:30pm, May 28th, 2014)
Please fill out the information below:
Player’s Last Name _____________________
Player’s Last Name _____________________
Player’s First Name _____________________ Home Phone number _______________
Parent’s Names: _______________________________
Parent’s Names: _______________________________
Father emergency contact number: _______________________________
Mother emergency contact number : ______________________________
Street Address City & Zip__________________________________________________
Street Address City & Zip__________________________________________________
Family e-mail address ___________________________________________________
Tryout Number Assigned _______________
PLAYER INFORMATION:
Player’s Date of Birth : _______________ # of Years playing soccer: ____________
Any competitive soccer experience: No Yes
Player’s favorite field position ________________________________________________
Team Child played for during 2013-14 Season ______________ (Team name, & division)
Name of any friends also attending tryouts: _________________________________________
Player’s Strengths: ___________________________________________________________
Player’s Weaknesses: _________________________________________________________
Willingness to play goal-keeper: Full-time High Moderate Low None
Name of any friends also attending tryouts: _________________________________________
Player’s Strengths: ___________________________________________________________
Player’s Weaknesses: _________________________________________________________
Willingness to play goal-keeper: Full-time High Moderate Low None
Parents, what’s your family history in the sport of soccer: ____________________________________________________________________________
List other organized sports/activities (with timeframes) the player will participate in through the next 12 months:___________________________________________________________
Is there any night per week in particular that is difficult to attend practice:
____________________________________________________________________________
Are they available to play on this team year round: No Yes , (please give detail)
List other organized sports/activities (with timeframes) the player will participate in through the next 12 months:___________________________________________________________
Is there any night per week in particular that is difficult to attend practice:
____________________________________________________________________________
Are they available to play on this team year round: No Yes , (please give detail)
____________________________________________________________ _______________
Participant and Volunteer Waiver
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT 1. IN CONSIDERATION of being permitted to participate in any Striker Soccer Club activity, an affiliation of Utah Youth Soccer Association and United States Youth Soccer Federation, I and/or my minor child, our personal representatives, assigns, heirs and next of kin.
2. I ACKNOWLEDGE, agree, and represent that I and/or my minor understand the nature of Striker Soccer Club and that I and/or my minor child are qualified, in good health, and in proper physical condition to participate in such activity. I further agree that if at any time I believe conditions or equipment to be unsafe, I and/or my minor child will immediately discontinue further participation in the activity.
3. FULLY UNDERSTAND that: (a) Striker Soccer Club activities involve risks and dangers of serious bodily injury, including permanent disability, paralysis and death ("risks"); (B) these Risks and dangers may be caused by me and/or my child’s own actions, or inactions, the actions or inactions of others participating in the activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and responsibility for losses, costs and damages I and/or my minor child incur as a result of my participation in the activity.
4. Hereby accept and assume all such risks, known and unknown, and assume all responsibility for the losses, costs, and/or damages following such injury, disability, paralysis, or death, even if caused, in whole or in part, by the negligence of the "releasees" named below:
5. Hereby release, discharge, and covenant not to sue Striker Soccer Club, their respective member teams and leagues, their administrators, directors, agents, officers, volunteers, team members and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the Activity takes place. (each considered one of the "releasees" herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise, including negligent rescue operations; and I further agree that if, despite this release and waiver of liability assumption of risk and indemnity agreement I and/or my minor child, or anyone on my and/or my minor child’s behalf, makes a claim against any of the releasees, I will indemnify, save and hold harmless each of the releasees from litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.
6. I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, not withstanding, shall continue in full force and effect.
7. I hereby give my permission, as the parent/legal guardian of the above named participant, to receive emergency medical care prescribed by a certified doctor of medicine and/or dentistry as deemed to be necessary.
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT 1. IN CONSIDERATION of being permitted to participate in any Striker Soccer Club activity, an affiliation of Utah Youth Soccer Association and United States Youth Soccer Federation, I and/or my minor child, our personal representatives, assigns, heirs and next of kin.
2. I ACKNOWLEDGE, agree, and represent that I and/or my minor understand the nature of Striker Soccer Club and that I and/or my minor child are qualified, in good health, and in proper physical condition to participate in such activity. I further agree that if at any time I believe conditions or equipment to be unsafe, I and/or my minor child will immediately discontinue further participation in the activity.
3. FULLY UNDERSTAND that: (a) Striker Soccer Club activities involve risks and dangers of serious bodily injury, including permanent disability, paralysis and death ("risks"); (B) these Risks and dangers may be caused by me and/or my child’s own actions, or inactions, the actions or inactions of others participating in the activity, the condition in which the Activity takes place, or THE NEGLIGENCE OF THE "RELEASEES" NAMED BELOW; there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and responsibility for losses, costs and damages I and/or my minor child incur as a result of my participation in the activity.
4. Hereby accept and assume all such risks, known and unknown, and assume all responsibility for the losses, costs, and/or damages following such injury, disability, paralysis, or death, even if caused, in whole or in part, by the negligence of the "releasees" named below:
5. Hereby release, discharge, and covenant not to sue Striker Soccer Club, their respective member teams and leagues, their administrators, directors, agents, officers, volunteers, team members and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the Activity takes place. (each considered one of the "releasees" herein) from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the releasees or otherwise, including negligent rescue operations; and I further agree that if, despite this release and waiver of liability assumption of risk and indemnity agreement I and/or my minor child, or anyone on my and/or my minor child’s behalf, makes a claim against any of the releasees, I will indemnify, save and hold harmless each of the releasees from litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.
6. I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it, and have signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid the balance, not withstanding, shall continue in full force and effect.
7. I hereby give my permission, as the parent/legal guardian of the above named participant, to receive emergency medical care prescribed by a certified doctor of medicine and/or dentistry as deemed to be necessary.
By my signature, I certify that I have read and agree to points 1- 7. X_______________________________________________ _______________
Parent/Guardian Signature Date
Parent/Guardian Signature Date
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