FC Tippecanoe tryout form

FC Tippecanoe Tryout Form
Name:
Gender:	Male Female
Date of Birth (MM/DD/YYYY):
Address:
City:
ZIP Code:
Email Address:
May we contact your child by email?:	Yes No
Child's Height:	feet inches
Child's Weight:	lbs
Parent Name:
Parent Phone Number:
Parent Relationship:
Guardian Name:
Guardian Phone Number:
Guardian Relationship:
Emergency Contant Name:
Emergency Contant Phone Number:
Emergency Contact Relationship:
School Next September:
Grade Next September:
Age on July 31, 2011:
Age Group:
Shirt Size:
Shorts Size:
Preferred Jersey Number:
Waiver and Statement of Understanding
I verify the above information is correct and hereby agree that the named participant is about to take part in soccer on a public facility owned and operated by the City of Tipp City or Monroe Township of Miami County and WHEREAS, the named participant is doing so entirely upon his/her own initiative, risk, and responsibility and with no fees of any kind levied by the owner/operator. NOW, THEREFORE, in consideration of the permission extended to the named participate by the City of Tipp City, Tipp-Monroe Community Services, Monroe Township of Miami County, Ohio, Tipp City Youth Soccer, Inc., and FC Tippecanoe, through its officers and agents to take part in said sporting event on or in a public facility owned and operated by the above named entities, we do hereby, for ourselves, our heirs, executors and administrators, remise, release, and forever discharge the above named entities and all of their officers, agents and employees, acting officially or otherwise, from any and all claims, actions, or causes of action, on account of participant's death or on account of any injury to participant which may occur from any cause during said use as well as any and all activities related thereto. By checking this box, I agree to the above Waiver and Statement of Understanding.