CUTLER BAY SOCCER CLUB 2007 REGISTRATION
P.O. Box 972203 Miami, FL 33197
Tel: 786-299-1542
Fax: 305-238-2950
serjio@cutlerbaysoccerclub.com
www.cutlerbaysoccerclub.com
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Please Complete Registration and Waiver. Print and Fax, Mail or E-mail to Address Above

**Make Checks Payable to Cutler Bay Sports Club**

PLAYER INFORMATION

Last Name:________________ First Name:_____________ Middle Initial: _____ (optional)

Street Address : ______________________________________________________

City: _____________________________State: ________________ Zip: _________

Home Phone:___________________Cell Phone: ____________________________

E-Mail Address: _______________________________________________________
Gender: (check one) Male:□ Female □    Height: ____ ft.___ in. Weight: ____ lbs. (optional)
Player Level: (check one) Recreational □ Competitive □
Are You 17 Years of Age or Older? (check one) Yes □ No □

Driver's License: ___________________________________ Age: _________

TEAM INFORMATION
Division Desired: (check one) Women's 5 x 5 □ Men's 8 x 8 □

REGISTRATION: (check one)
Register as an Individual: ($85): □ : □
(10% Discount on 2nd Team Registration Applied))

Team Name:__________________ (If you register as an individual, we will assign you to a team)

Jersey size: (check one)
Small □   Medium □   Large □   Xlarge □ TEAM-No Size




Signature _________________________________________________________

Date Signed:_______________________________________________________

 

 

WAIVER AND RELEASE OF LIABILITY

Read Prior to Signing

In consideration of being allowed to compete, officiate, observe or participate in any way in Cutler Bay Sports Club and any of its affiliate athletic sports program, related events and activities, the undersigned acknowledges, appreciates and agrees that:

  1. The risk of injury from involvement in this program is significant, including the potential for a variety of permanent injuries and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERS, AND ASSUME FULL RESPONSIBILITY FROM MY PARTICIPATION; and
  2. I willingly agree to abide by the stated and customary terms and conditions for participating. If however, I observe any unusual significant hazard during my presence and/or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and,
  3. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless Cutler Bay Sports Club, Cutler Bay Soccer Club, Cutler Bay Runners Club, the Town of Cutler Bay their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and owners and lessors of premises with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from the negligence of the releasees or otherwise.
  4. I will not be allowed to participate in present and future leagues and related events if my behavior is deemed disruptive or unsafe by officials and my registration fee will be forfeited.
  5. No refunds will be granted after the start of the season except under extenuating circumstances subject to approval by the director of Cutler Bay Sports Club.
  6. I have no known medical condition that would prohibit me from participating in the sport of soccer, running, volleyball, softball, or kickball. Cutler Bay Sports Club strongly recommends that you, the player, receive a medical physical examination before participating in any sporting event.

I AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT AND SIGN IT FREELY AND VOLUNTARILY.

Your signature below indicates that you’ve read, understood and agree to adhere to the league’s Rules & Regulations AND Release of Liability Waiver.

(This is available on the league’s web site & at all games.You must be 17 yrs or older to play at Cutler Bay Soccer Club)

____________________________________
Participant’s Name

____________________________________  ______________________________
Participant’s Signature                                      Date Signed