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WESTERN SOCCER LEAGUE Revised 3/10/2008 Boy's HOLD-HARMLESS FORM Each player participating in the WESTERN Soccer League must have the following form signed by both parents/guardians. Team officials should make enough copies for the team members and forward the signed copies to Jim Luzzi by June 2, 2008 along with their team roster. Players CANNOT participate without this signed statement and proof of insurance. I/WE hereby give my/our son permission for the participation of my/our son in the athletic program of the Western Soccer League. I/We understand that the Western Soccer League, their coaches, players, representatives and referees, in this activity, will exercise care and caution. I/We agree to Hold-Harmless the Western Soccer league, its' Coaches, players, representatives and playing field property owners involved in this activity. I/We furthermore certify that my/our child is covered by my/our accident and medical insurance policy. I/We furthermore certify to the best of my/our knowledge based on medical examinations that the participant suffers from no pre-existing medical condition, which would be aggravated or injurious to the participant in this activity. Click on Box and type
information. When complete, click print button at the bottom of the
page. NO INFORMATION IS
PASSED THROUGH THE INTERNET. Sign
and mail form.
Name of Participant:
Insurance Company: Policy Number: Signature of Parent(s) or Guardian(s): _______________________________/______________________________________ Date: ______________________
I agree to play by the rules of the WESTERN Soccer
League. Furthermore, I agree to demonstrate good sportsmanship in each
game I play in, showing respect for my opponents, the Coach's, the Referees and
my teammates.
Participants Signature & Graduation Year: _________________________________________
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