Form Also used for 2004 Boys
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    (BE SURE ALL REQUIRED FIELDS ARE COMPLETED)
    Player Information

    Parent/Guardian Information

    Player Participation & Payment Agreement - Liability Waiver

    I/we as the parent/legal guardian of the player named above, do hereby declare our intent to allow this child to practice, play, and participate in all programs and  activities associated with the Pleasure Island Soccer Association, including any related activities and transportation. We/ I hereby release and hold harmless from any and all liability; Pleasure Island Soccer Association, its coaches, sponsors, associated 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 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 any x-ray, anesthetic, medical or surgical diagnosis or treatment or hospital care, to be rendered to the player under the general or special supervision and on the advise of any physician, dentist or surgeon duly licensed to practice, be indeed rendered to the Registrant.

    We/I understand there are hard costs associated with this program and for my child to play, and  we/I agree to pay the player participation fee for our child in the amount outlined in the estimated player budget. Once registered, a non-refundable fee will be assessed for player commitment / start-up and administrative costs to register your player. We/I understand actual costs may fluctuate slightly from the original estimated budget based on actual costs and number of tournaments entered, other games played, rained-out events; but agree regardless to reimburse (Pleasure Island Soccer Association, Inc.) PISA for any monthly dues owed on the 1st day of each month (if making monthly installments) as explained in the team budget for the Season, and agree to final monthly payment or remaining balance in full on or before last month of season or it may affect player's ability to participate in final event(s) of the season. Deposit can be paid online or by mail to PO Box 1868, Carolina Beach NC 28428 and is due immediately upon registering to guarantee placement on team. *$5 convenience fee is applied to online payments.
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     By clicking the Submit button below, you agree to have read the Player Participation Agreement.