Spring 2012 Registration

The undersigned parent or legal guardian of the above named child recognizing that the sport of soccer does contain elements of risk and possible injury does hereby consent to and give approval for the above child to participate in any and all league activities during the current seasonal year . I assume all risks and hazards incidental to such participation in any and all league activities during the current seasonal year including but not limited to transportation to and from activities. I do hereby waive, release, absolve, indemnify, and agree to hold harmless SMSL, its officers, board of directors, coaches, assistant coaches and any person acting by or on behalf of SMSL for any claim arising out of or in any way connected with injury the child may receive while participating in SMSL activities. I also grant permission for persons associated with SMSL to authorize and obtain medical care from any licensed physician, hospital, or medical clinic should the child become ill or injured while participating in SMSL activities away from home or at any other time when neither parent or guardian is available to grant authorization for medical treatment.

Signal Mountain Soccer League
Spring 2012 Player Registration
Please fill in all fields marked with a *
	Player's First Name	*
	Last Name	*
	Street Address	*
	City
	State
	Zip
	Home Phone	* (xxx-xxx-xxxx)
	Cell Phone	(xxx-xxx-xxxx)
	Birth Date	*(MM/DD/YYYY)
	Gender	Male Female *
	Mother
	Father
	Email Address
	Player's Skill Level	Beginner Intermediate Experienced
	Can you volunteer to help?	Age Group Commissioner Coach Assistant Coach Field Help Other
	Form of payment	Credit Card (add $2) Send By Mail
Parental Authorization/Release of Liability The undersigned parent or legal guardian of the above named child recognizing that the sport of soccer does contain elements of risk and possible injury does hereby consent to and give approval for the above child to participate in any and all league activities during the current seasonal year . I assume all risks and hazards incidental to such participation in any and all league activities during the current seasonal year including but not limited to transportation to and from activities. I do hereby waive, release, absolve, indemnify, and agree to hold harmless SMSL, its officers, board of directors, coaches, assistant coaches and any person acting by or on behalf of SMSL for any claim arising out of or in any way connected with injury the child may receive while participating in SMSL activities. I also grant permission for persons associated with SMSL to authorize and obtain medical care from any licensed physician, hospital, or medical clinic should the child become ill or injured while participating in SMSL activities away from home or at any other time when neither parent or guardian is available to grant authorization for medical treatment.
	Signature	*
	Date	* (MM/DD/YYYY)