MANHASSET SOCCER CLUB, INC.

P.O.BOX 341

MANHASSET, NEW YORK 11030

Fall 2001 INTRAMURAL & TRAVEL REGISTRATION FORM

IN EVENT OF EMERGENCY, PLEASE CALL-

PLEASE NOTE: all children with a medical condition are required to submit written approval from their physican to the Program Director prior to team assignment.

REGISTRATION FEE -Travel/ Intramurals-Grades K-3 -$95.00  Pre-K $50.00 – Make check payable to: Manhasset Soccer Club

IT IS UNDERSTOOD BY PARENT OR LEGAL GUARDIAN THAT:

In consideration of the Manhasset Soccer Club, CYO and the LUSL allowing my child to participate in league and club activities I, the parent or legal guardian of _____________________hereby approve of child’s participation in all of Manhasset Soccer club activities through the fall 2001 soccer season. Recognizing the possibility of physical injury associated with soccer and/or the aggravation of an existing physical condition and the natural consequences that may follow I assume all risks and hazards to my child’s participation in such activities, including the transportation to and from such activities. I hereby waive, release and/or otherwise identify and agree to hold harmless the Manhasset Soccer Club. CYO and the LUSL and their respective officers, directors, employee, agents, representative, assistant coaches, as well as my individual officiating any Manhasset Soccer Club activity from any claim arising out of an injury or illness (including death) to my child, whether the result of negligence or from any other cause, except to the extent and in the amount covered by any accident or liability insurance policy maintained by the League and/or club. My child has received a physical examination by a physician and has been found capable in participating in club activities without restrictions. I am in a position to furnish upon request, by the Manhasset Soccer Club, Inc., a certified copy of the birth certificate of the above named candidate.