Sign Up Sheet - Last Dream Soccer Club printable pdf download

Last Name:

(Please print)

First Name:

Date of Birth:

(Actual)

Address:

City:

State:

Zip:___________

Telephone:

Mobile:

email:

Country of Origin:

In case of Emergency

Person to contact:

Phone:

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

herein.

Signature:

Date:

Season Fee: $150 or $75 (Wednesday) NO REFUNDS

Check #:

Cash:

Proof of Age required.

ID verified by:

FL DL:

Current Team:

US Passport:

Jersey Number: _______________________

Would you be interested in having supplemental insurance to cover you and your family in case of

catastrophic injury?

Yes []

No []

Sign Up Sheet - Last Dream Soccer Club