Note: The statement should be signed by a legal guardian, for himself; an adult player for himself; coach for himself; administrator for himself.
I, the parent/guardian of the registrant, a minor , or adult registrant of legal age, agree that I and the registrant will abide by the rules of EPYSA, Chester City United Soccer Club and its affiliated organizations and sponsors. Recognizing the possibility of physical injury and/or death associated with soccer and its related activities and in consideration for the EPYSA, CCUSC, accepting the registrant for its soccer programs and activities (the "Programs"), I hereby release discharge and/or otherwise indemnify the EPYSA, Chester City United Soccer Club, the Board of Directors and staff, its affiliated organizations and sponsors, their employees ad associated personnel, including the owners of the fields and facilities utilized for the programs, against any claim by or on behalf of the registrant as a resultt of the registrant's participation in the programs, and/or being transported to or from the same, which transportation I hereby authorize.
By initialing here I certify that I have read and understand the rules and regulations listed above:
(Parent or Guardian, please initial.)