Futsal Registration Form

Name

First NameLast Name

Birth Date

MonthDayYear

Cell Phone

Format: (000) 000-0000.

E-mail

example@example.com

Parent/Guardian Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Will be willing to travel for tournaments i.e. Local & International

Years Playing Futsal

Which program you would like to register?

Medical History and/or comments

In consideration of the Organization allowing me to participate, I agree: a) To assume all risks arising out of, associated with or related to my participation; b) To be solely responsible for any injury, loss or damage that I might sustain while participating; and c) To release the Organization from liability for any and all claims, demands, actions and costs that might arise out of my participating, even though such risks, injuries, loss, damage, claims, demands, actions or costs may have been caused by the negligence of the Organization.

I agree to the above conditions

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