Sign Up Sheet
Date of Birth:
Country of Origin:
In case of Emergency
Person to contact:
Name & telephone of your health insurance company:
Release of all claims
,understand that participation can involve RISK OF INJURY,
including, but not limited to, death, serious neck and/or spinal injuries and other serious injuries and/
or impairment to the body.
I hereby agree to hold the Last Dream Soccer Club, its employees, agents, representatives, coaches and
volunteers harmless from any and all liability, actions, causes of action, debts, claims or demands of
any kind and nature whatsoever which may arise by or in connection with my participation in
activities related to the Last Dream Soccer Club.
The terms hereof shall serve as a release for my heirs, estate, executor, administrator, and any
assignees and for all members of my family.
I have read the foregoing and understand and will abide by all of the principles and regulations
Season Fee: $150 or $75 (Wednesday) NO REFUNDS
Proof of Age required.
ID verified by:
Jersey Number: _______________________
Would you be interested in having supplemental insurance to cover you and your family in case of