GASL 2012 REGISTRATION

Last Name:First Name:

Date of Birth: Male/Female:

E-Mail:Phone Number:

Address: Town ,NY

Zip CodeEMERGENCY CONTACT:Phone Number:

Medical Condition

Indicate player's special medical condition(s). This is mandatory. If no such condition, write "none"

Medical:

I understand that soccer is a contact sport and that although efforts will be made to provide safe and orderly game conditions, there will always remain a chance of serious injury. Recognizing the risk, I have elected to participate in the Guilderland Adult Soccer League I acknowledge that participation in the sport of soccer involves risk of injury. Therefore, I release the Guilderland Youth Soccer Association Inc., GASL, its Players, Officials, and the Town of Guilderland, from the liability or responsibility from and injury I may sustain while participating in this league.

In consideration for being allowed to participate, in any way, in the GYSA/GASL and related events and activities, the undersigned:

(1) Agrees that before participating, they will inspect the facilities and equipment to be used, and if they believe anything to be unsafe, they will immediately advise

their coach, representative or official of such condition(s) and refuse to participate.

(2) Acknowledges and fully understands that by participating they will be engaging in activities that involve risk of serious injury, including permanent disability and

death, and severe social and economic losses which might result not only from their own actions, inactions or negligence of others, the rules of play, or the

condition of the premises or of any equipment used. Further, that there may be other risks not known or not reasonably foreseeable at this time.

(3) Assumes all the foregoing risks and accepts personal responsibility for the damages following such injury, permanent disability or death.

(4) Releases, waives, discharges and covenants not to sue the GYSA/GASL, its affiliates, their respective administrators, directors, agents, coaches, referees, and

any other employees or volunteers of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasers of

premises used to conduct the event, all of which are herein after referred to as "releasees", from demands, losses or damages on account of the injury,

including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise.

(5) Understands that the GYSA/GASL does not maintain liability insurance for bodily injury, liability for loss or damage to personal possessions, but that such

insurance is the responsibility of said player.

(6) Agrees if they are serving as team manager, they are responsible for making sure ALL persons playing on their team are registered within the GASL

league. The team manager will be held liable for using illegal players who have not registered with the league.

(7) Is at least 17 years of age.

THE UNDERSIGNED HAS READ THE ABOVE WAIVER AND RELEASES, UNDERSTANDS THEY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGNS IT VOLUNTARILY. THE PLAYER FURTHER AGREES BY SIGNING THIS WAIVER TO ABIDE TO ALL CURRENT GYSA/GASL RULES.

The submission of this form and remittance of payment will constitute acceptance of these terms.

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