www.UrbanSoccer.com
Free Agent Registration 2015-16
Team Name:
Name:
Play It Here!
Signature:
Address:
Office Use Only
Email:
Phone:
# of T-Shirt: _________
Shirt Color: _________
Emergency Contact:
Amount Paid: ________
Emergency Contact:
Check #: ____________
Men:
Mon/Tues ____ Tues - Thurs ____ Fri ____ Sat/Sun ___
Coed:
Mon/Weds ___ Tues-Thurs ____ Fri ____ Sat/Sun ___
Women: Tues/Thurs
Comments:
Date:_______________
Signature: ___________
Participant Release and Waiver of Liability: Each team member and/or participant (hereafter referred to as "Participant") listed on the above
roster or added to the roster at a later date, intending to be legally bound, hereby certifies that he/she is physically fit and in normal health and
has not been otherwise informed by a physician that he/she is incapable of participation in any sport Leagues/clinics/tournaments, including
those organized by Urban Soccer League (hereafter referred to as "USL LLC") Each participant agrees to abide by all USL LLC rules. Each
participant acknowledges that he/she is aware of the risks inherent in participation in sports [both practice and competition]; that sports are
physical and can require considerable running, starting, stopping and physical exertion, in heat and humidity, and could potentially lead to
injuries including, but not limited to, overheating dehydration, limb injuries and possible permanent disability and death. USL LLC does not
carry player medical insurance, nor provide event security, each participant agrees to assume all those risks, including, but not limited to,
property damage and serious bodily injury arising from fair or foul play (including death), and to waive any and all rights to claim for injuries,
loss or damages arising out of his/her participation in USL LLC. The Undersigned hereby release(s) and discharge(s) the League Organizers,
including USL LLC, and their respective assignees, successors, officers, directors, agents, representatives, employees, subcontrators,
sponsors, partners, members and affiliates from all present and future liabilities, debts, obligations, costs, expenses, damages, losses,
charges, judgments, executions, liens, claims, demands, actions or causes of action of whatever nature or description, in equity or at law,
which the Undersigned may have, whether known or unknown, suspected or unsuspected, asserted or not asserted, arising out of participation
by the Undersigned in USL LLC. Each participant is responsible for conducting him/herself safely and at a level consistent with his/her skill.
Each participant must further certify that he/she maintains adequate health insurance to cover any injuries occurring as a result of participation
in order to register in USL LLC. The Undersigned understands, acknowledges, and accepts that this Participants Release and Waiver of
Liability is intended to be as broad and inclusive as permitted by the laws of the State of New York and agrees that if any portion of this
Release and Waiver of Liability is invalid, the remainder will continue in full legal force and effect. The Undersigned further agrees that any
legal proceedings related to this Release and Waiver of Liability shall take place in the City of New York.
Participant Signature __________________________________________________________ Date __________________
Payment Method:
Visa__ MasterCard __ Credit Card Number_____________________ Exp. _____ CCV_____________
I authorize Urban Soccer League to bill the above credit card for the amount due for the selected sessions.
SIGNATURE: _________________________________________________________ DATE: _________
*Any returned checks will be subject to a $15 service charge plus any bank charges.
REGISTRATION REQUIREMENTS: Please mail this entry form, the completed Release and Waiver of Liability, picture ID copy
(Drivers License), payment $175 (credit card, check or money order payable to USL).
Mail Form to: Urban Soccer League, A/R Dept., 139 Centre St . PH#138, New York, NY 10013