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Medical Treatment Authorization and Liability Waiver
I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment.
I understand treatment for injury will be based on information provided herein.
I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted.
I recognize the possibility of physical injury associated with soccer, and hereby release, discharge, and otherwise indemnify the club, US Club Soccer, their sponsors, the USSF and its affiliated organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the soccer player named above as a result of that player’s participation in US Club Soccer programs and/or being transported to or from the same, which transportation I hereby authorize.
I grant to Upper Rogue United Futbol Club, its representatives and employees/volunteers the right to take photographs of me and my property. I authorize Upper Rogue United Futbol Club, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Upper Rogue United Futbol Club, may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.
Confirmation & Signatures
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
I ALSO AGREE THAT I HAVE READ AND AGREE WITH THE MEDICAL TREATMENT AND AUTHORIZATION AND LIABILITY WAIVER.
Note - Once a player is rostered on a team no refunds will be given.
The Seasonal Fee to play is $150.00.
All players MUST PAY FEES in order to participate. No player will be rostered on a team until either fees are paid in full or payment arrangements have been made.
Payments must be submitted to Lucas Gomez.
*Payment plans are available. Please contact the club registrar at URURegister@gmail.com to apply. Payment plan requests must be submitted for each season. A deposit per player is required in order to initiate this option. A payment schedule must be arranged when establishing the plan with the registrar and the final payment of registration must be paid prior to opening weekend.
Thank you for Registering!
PLEASE HIT THE SUBMIT FORM BUTTON BELOW TO PROCESS YOUR REGISTRATION.
You should receive a confirmation email after clicking the "Submit Form" below.
If you do not get an email please contact our Club Registrar at URURegister@gmail.com.