BAY AREA FUTSAL

Player Information

Player's Name*

First NameLast Name

Birth Date*

MonthDayYear

Grade*

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent/Guardian Information

Name*

First NameLast Name

Cell Number*

Home Number

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number

Does the player have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Is the player prescribed an inhaler? If yes, please explain any instructions.*

Informed Consent and Acknowledgement

I hereby provide my consent for my child's participation in all activities organized by the BAY AREA INTERNATIONAL FC during the chosen game session. By accepting my child's participation, I acknowledge and accept all the potential risks and hazards associated with these activities. I release, exempt, and indemnify the soccer camp and all its officials, representatives, and agents from any responsibility for injuries that may occur to my child during the game time.

If my child sustains an injury, I waive any claims against BAY AREA INTERNATIONAL FC, including its coaches, affiliates, fellow participants, supporting organizations, advertisers, and, if applicable, the owners and landlords of the premises where the event is held. Engaging in sports activities, including soccer, inherently carries a risk of injury, which may include but is not limited to fractures, paralysis, or even fatality.

Medical Release and Authorization

As the legal guardian of the youth player listed, I hereby grant permission for qualified and licensed medical professionals to diagnose and administer treatment in the event of a medical emergency. This authorization is applicable when, in the medical professional's judgment, immediate attention is necessary to prevent further harm to the minor child's life, physical appearance, physical functionality, or to alleviate undue pain, suffering, or discomfort should there be a delay in treatment.

I hereby give consent to the attending physician to undertake any necessary medical or minor surgical procedures, conduct X-ray examinations, and administer immunizations to the youth player named. In cases of a serious illness, the requirement for major surgery, or significant accidental injury, I am aware that the attending physician will make every reasonable effort to contact me as swiftly as possible before proceeding with treatment. This authorization is granted after a reasonable attempt has been made to reach me.

I also authorize the affiliated individuals, including Directors, Coaches, and Team Parents, to provide essential emergency treatment before the child is admitted to a medical facility.

This consent is valid during the dates and for the duration of the registered season. I willingly provide this authorization to ensure prompt medical treatment under emergency circumstances, safeguarding the life and well-being of the named minor child when I am not present.

Signature*

I hereby grant permission to BAY AREA INTERNATIONAL the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of my child for the purpose of publication, promotion, and illustration in any manner or in any medium, including on the Internet and social media platforms*

I agreeI don't agree

Shirt size*

My Products*

Futsal Premier League fees

$110.00

Premier League shirt

$35.00

Total

$0.00

Credit Card