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Moscow Mamba Soccer Registration Form

Primary Contact Parent Information

Optional Additional Parent Information

Optional Additional Parent Information

Player Information

Emergency Contact (if different than Primary Parent listed above)

Waiver

As the parent/legal guardian of this participant, I hereby grant permission for my child to participate in the Moscow Mambas Soccer Club. In the event of illness or injury, we hereby authorize the representatives of the camp to obtain assistance from doctors, nurses or athletic trainers for medical, surgical or any other appropriate treatment for the above mentioned child. The parent(s)/legal guardian(s) of the minor child/player listed, and on behalf of their family, by signing this Moscow Mambas Waiver form, I hereby voluntarily release, waive, relinquish, and discharge the Moscow Mambas and all affiliated coaches, athletes, directors, representatives, and volunteers from any and all liabilities, claims, suits, actions, or causes of actions (whether anticipated or unanticipated) arising out of any and all actions, injuries, death, or damages of any nature incurred while participating in, or traveling en route to, and from the club games and practices. The terms of this release and waiver are applicable to all games and activities, and all off the field actions while participating in the club. The parent/legal guardian referenced below is solely responsible for providing for its own medical insurance for the players listed on this form and shall hold harmless the above organizations from any and all claims arising from their participation, whatsoever.

Parent/Guardian Signature

Signature

Payment

Fall season cost is $50/player. Please bring cash payment to the Parent Meeting during the first week of practice. More details coming.