TROJAN FUTSAL LEAGUE

Player Information

Player's Name*

First NameLast Name

Birth Date*

MonthDayYear

Players Birth Year*

Gender*

MaleFemale

What event are you taking participating in?*

LeagueProgramTournamentLesson or Group Session

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent/Guardian Information

Name

First NameLast Name

Home Number

Cell Number

Relationship

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

E-mail

example@example.com

Does the player have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the player prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby provide my consent for my child's participation in all activities organized by The Soccer Hub before, during and after the chosen league games. By accepting my child's participation, I acknowledge and accept all the potential risks and hazards associated with these activities. I release, exempt, and indemnify the The Soccer Hub and all its officials, representatives, and coaches from any responsibility for injuries that may occur to my child during their travel to, engagement in, or return from The Soccer Hubs League(s) and events.

If my child sustains an injury, I waive any claims against The Soccer Hub, including its coaches, affiliates, fellow participants, supporting organizations, advertisers, and, if applicable, the owners and landlords of the premises where the event is held. Engaging in sports activities, including soccer, inherently carries a risk of injury, which may include but is not limited to fractures, paralysis, or even fatality.

Medical Release and Authorization

As the legal guardian of the player listed, I hereby grant permission for qualified and licensed medical professionals to diagnose and administer treatment in the event of a medical emergency. This authorization is applicable when, in the medical professional's judgment, immediate attention is necessary to prevent further harm to the minor child's life, physical appearance, physical functionality, or to alleviate undue pain, suffering, or discomfort should there be a delay in treatment.

I hereby give consent to the attending physician to undertake any necessary medical or minor surgical procedures, conduct X-ray examinations, and administer immunizations to the youth athlete named. In cases of a serious illness, the requirement for major surgery, or significant accidental injury, I am aware that the attending physician will make every reasonable effort to contact me as swiftly as possible before proceeding with treatment. This authorization is granted after a reasonable attempt has been made to reach me.

I also authorize the affiliated individuals, including Directors, Coaches, and Team Parents, to provide essential emergency treatment before the child is admitted to a medical facility.

This consent is valid during the dates and for the duration of the registered season. I willingly provide this authorization to ensure prompt medical treatment under emergency circumstances, safeguarding the life and well-being of the named minor child when I am not present.

Photo Consent

I understand that The Images wherein I am included as the subject or one of the subjects shall be or are in the possession of the company, and by which shall be used only as agreed upon by me and the company, in accordance to the choices I have given above and in accordance with the terms and conditions set forth in compliance with the General Data Protection Regulation 2016/679 (GDPR) guidelines.

I understand that the company shall not share, use, disclose, lease, or sell the photographic images without my knowledge and prior written consent.

I understand that I may withdraw this consent anytime and upon withdrawal, the company shall cease publishing any material which includes the Images contained in this agreement.

By signing this form, I am confirming the stipulations stated above. I am executing this form with full knowledge and consent and free from any representation, inducement, or duress.

Parent/ Guardians Name*

First NameLast Name

Date*

Date

Signature*

TSC Participant Waiver