Youth Registration     Print
       



 

Youth registration and release form for TASFACA only

Parent/Guardian Authorization, release and waiver of liability, indemnity agreement. Minor's Request for permission to Participate in TASFACA program.

 

 Minor Player's Last name* 

  

Firs Name * 

 

Middle Name  

 

D.O.B. * 

 

Male/Female *

   
  Parent(s)/Guardian(s)

Father/Mother * 

 

   
  Mailing address

Address * 

 

City * 

State / Province * 

Zip Code * 

   

 Country * 

Email * 

Phone * 

  

Cell Father 

Cell Mother  

   

   
  Above mentioned player HAS NO medical condition which will hold him/her from participating in TASFACA programs.
   
  Insurance information

Name of Doctor   

 

Phone  

  

Insurance Company 

 

 

  

   
   

TASFACA Programs: Soccer-Futsal-Travel-Tournaments 

The above-mentioned, requests to register and participate with TASFACA.  The undersigned hereby convent NOT to sue, and release, waive, and discharge the TASFACA , its Board of Directors or the PROPERTY OWNER where this activity is held (all for purposes herein referred to as the “Organization”) from all liabilities, claims, actions, damages, costs or expenses which all of the undersigned, their heirs, family members, executors, administrators and personal representatives may have against any of the Organization arising out of or in any way connected to the above-mentioned  participation including travel to or from the activity, bodily injury, death or property damage suffered by the above-mentioned  before, during or after any participation.  The undersigned understand that the release and waiver includes any claim or action based on the negligence, action or inaction of any releaser, or otherwise. THE UNDERSIGNED expressly acknowledge and agree that the aforesaid activity may involve the risk of property damage, injury and/or death. THE UNDERSIGNED ASSUME FULL RESPONSIBILITY FOR RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE due to the negligence of releasers or otherwise while competing, observing, or participating in any other way in the activity. THE UNDERSIGNED shall defend, hold harmless and indemnify the Organization, its officers, employees and agents, from and against all liability, loss, claims, damages, costs, attorney’s fees and expenses of whatever kind or nature which the above-mentioned minor may sustain, suffer, or incur or be required to pay by reason of the undersigned minor participating in the aforesaid activity, even if allowing the undersigned minor to do so is later found to be wrongful or negligent. THE UNDERSIGNED further expressly agree the forgoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the laws of the State of Florida or other State where a claim of action may be instituted and that if any portion thereof is held invalid, it is agreed that the balance shall notwithstanding continue in full legal force and effect.

 *

 I/we have read this instrument and understand all its terms.
*

 I/we execute it voluntarily and with full knowledge of its significance 

 

  

* Required Fields

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