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Application Form Winter Indoor Season 2011-2012

CLUB NAME ______________________________________________

COACH ________HOME TEL_________________WORK TEL__________

ADDRESS________________CITY___________ STATE___ZIP_____

COACH E-MAIL____________________________________________

MANAGER____________HOME TEL_______________WORK TEL_________

ADDRESS________________CITY_____________STATE_____ZIP_______

MANAGER E-MAIL______________________________________________

SELECT TOURNAMENT(S): SEASON # 1___ ($250) Season # 2___ ($250) Both___ ($500). (Check √ appropriate box)

(11/26/2011 – 1/28/2012) (2/3/2012 – 3/24/2012) (11/26/2011 – 3/24/2012)

Referee Fees are $10 per team per game. Please pay the table before your team plays

Accepting teams for: U7, U9, U 11, U 13, Girls Open, and HS age divisions.

PLEASE ENTER TEAM(S): BOYS UNDER_____________________________________ GIRLS UNDER______

Please complete and send this form with check for $250.00 PER TOURNAMENT made payable to F.C.Vipers c/o Rudolf Sanchez , 37-31 32^nd Street. L. I. C., NY 11101.

Should you require additional information, please contact Rudolf Sanchez at (646) 379-3053

or e-mail rudolfsanchezii@aol.com

For more information please call Rudolf Sanchez (646) 379-3053.

Indoor Roster 2011-2012

ASSUMPTION AND ACKNOWELEDGEMENT OF RISKS AND RELEASE OF LIABILITY AGREEMENT

In compliance of being allowed to participate in any way for the FC Vipers Hosts: New York City Soccer League Tournament, : "The League", it's related events and activities, the undersigned, acknowledges, appreciates, and agrees that: 1.) The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of injury does exist; and 2.) I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsibility for my participation; and 3.) I willingly agree to comply with the stated and customary items and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will bring such to the attention of the nearest official immediately; and 4.) I, for myself and behalf of my heirs, assigns, personal representatives and next of kin, Hereby release, indemnify, and hold harmless "The League," its officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leasers of premises used to conduct the event("Releases"). With respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the releases or otherwise, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK MANAGEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS FORM, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Parent/Legal Guardian may sign on behalf of player below.

TEAM NAME: _________________AGE_U-______

LEAGUE: NEW YORK CITY SOCCER LEAGUE

SEASON: WINTER 2011-12 Tournament

NAME SIGNATURE DATE Shirt # Color Uniform

1. ______________ _______ _________ _____ ___________

2. ______________ _______ _________ _____ ___________

3. ______________ _______ _________ _____ ___________

4. ______________ _______ _________ _____ ___________

5. ______________ _______ _________ _____ ___________

6. ______________ _______ _________ _____ ___________

7. ______________ _______ _________ _____ ___________

8. ______________ _______ _________ _____ ___________

9. ______________ ______ _________ _____ ___________

10. ______________ ______ _________ _____ ___________

1. Coach/Manager_______ _______ Tel. ___________ E-Mail

2. Coach/Manager_______ _______ Tel. ___________ E-Mail

Team and Player Registration: Upon acceptance of teams, the player is bound to his/her respective team.

A player cannot be registered in more than one club during the same season, unless proper release from current team and fee paid to League are met. "The player assumes all risks and responsibility for loss, damage, or injury to himself or herself while engaged as a player for the club or while using the property and facilities of the club, whether such loss, damage, or injury be occasioned by the club, the league, its agents, employees, or otherwise. This Association refutes any and all claims for damages and costs arising out of such loss, damage or injury."

By registering above, the teams and players have read and agreed to accept the conditions included within these statements, and bylaws of organizations and associations with which the league may be associated with. Recognizing the possibility of physical injury associated with soccer and in consideration for NON AFFILIATED, AND AFFILIATED sanctioning bodies, including USYSA/USASA/USCLUB/USSF, its directors and officers, and its affiliates including their directors and officers, as well as the Metropolitan Area of New York and New York City, and their respective officers and their directors, nor the FC Vipers, and their respective officers and their directors, nor NY Salamina Soccer Club, and their respective officers and their directors. By accepting the above named player(s) and teams for its Soccer Programs and activities (the Programs), I hereby release, discharge, and/or otherwise indemnify USYSA/USASA/USCLUB/USSF, its directors and officers, and its affiliates including New York City Soccer League, FC Vipers, NY Salamina SC, NYC Parks and Recreation, Sunset Park Recreation Center in Brooklyn, PS 171 Astoria Queens, their directors and officers, as well as the Metropolitan Area of New York and New York City and their respective officers and directors, and any of their sponsors, their employees and associated personnel, coaches, managers, trainers, and officials, including the owners of fields and facilities utilized for the Programs, against any claim by or on behalf of the above named Teams and Players participation in the Programs Entering information acknowledges Teams and their players have received physicals, and are capable in participating in the Programs.

http://www.sportssignup.com/FC-Vipers-Online-Registration.start