* Tournament
Committee reserves the right to combine 2 age groups to make one
division
Player Roster
Information - Minimum 4 players/maximum 8 players per team.
Players may not dual roster.
1. First: Last:Birth
date: //
2. First: Last:Birth
date: //
3. First: Last:Birth
date: //
4. First: Last:Birth
date: //
5. First: Last:Birth
date: //
6. First: Last:Birth
date: //
7. First: Last:Birth
date: //
8. First: Last:Birth
date: //
Waiver of
Liability:
We/ I, as the parent/legal
guardian of the player named above, do hereby declare our intent to
allow this child to play and participate in the Carolina Sand Blast.
We/ I hereby release and hold harmless from any and all liability; US
Club Soccer, Pleasure Island Soccer Association, its coaches,
sponsors, board members and personnel, officials, or any others
associated with this organization against any claim by or on behalf of
the player’s participation in this program. We/I
recognize the possibility of physical injury associated with soccer,
and hereby release, discharge, and otherwise indemnify Pleasure Island
Soccer Association, US Club Soccer, their sponsors, the USSF and its
affiliated organizations, and the employees and personnel of these
organizations, against any claims.
Medical
Consent Release:
We/ I do hereby authorize
Pleasure Island Soccer Association or any representatives including
coaches, officials, or anyone associated with this organization, if
after reasonable attempt has been made to reach the designated
parent/guardian named above to consent, or if sound medical practice
decrees that there is not time to make such an attempt, to
consent to have an athletic trainer, coach, team manager, emergency
medical technician, nurse, medical treatment facility, and/or doctor
of medicine or dentistry or personnel provide the participant named
below assistance and treatment and agree to be financially responsible
for the cost of such assistance and/or treatment, and authorize
emergency transportation of the participant to a medical treatment
facility should it be warranted.
Team
Coach/Manager
signature:________________________________________________
BY MAIL: Send
form and $40 per player (min. entry fee $200 per team) to: Carolina
Beach Sand Blast, PO Box 1868, Carolina Beach, NC 28428.
Pay ONLINE: Use
Paypal on the “Registration” page to pay, then Email this completed form to
Admin@pleasureislandsoccer.com or fax to
910-458-4263 no later than deadline below.
5th Annual
Carolina Beach