2015 Adult Outdoor League Registration
Registration Deadline: June 1, 2015
Team Price: $65/player
Player Name: __________________________________________ Birth Date: _______________
Parent / Guardian Name: _________________________________________________________
Address: ______________________________________________________________________
Preferred Contact Number: _______________________________________________________
Information below is used for team communications such as practices, travel and lodging. Enter contact info for
team manager.
Player email address & texting number: _____________________________________________
Other contact info: ______________________________________________________________
Mother’s Birthdate (month & day) _____________ needed to assign player registration number & for NDSA insurance
Eligibility and Waiver Form
As a legal adult or parent and legal guardian of ___________________________, I hereby consent medical care prescribed by
a licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to
preserve life, limb and well-being on me or my dependent.
We further acknowledge that the registrant and I will abide by the rules of US Youth Soccer (USYS), its affiliated organizations
and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the USYS accepting
the registrant for its soccer programs and activities, I hereby release, discharge and/or otherwise indemnify the USYS, its
affiliated organizations and sponsors, their employees and associated personnel, including the owner of the fields and
facilities for the programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the
programs and/or being transported to or from the same, which transportation I hereby authorize.
Signed: ______________________________________________________ Insurance Co. ____________________
Date:______________________________
Minot Soccer Use:
Fees paid & date: ______________________
Player ID #: ___________________________
MSA Adult Outdoor League Roster
June 17 – July 24
Optimist Soccer Complex
Registration Deadline: June 1, 2015
Team Price: $65/player
Ages 16 and up – Max 14 players per team
Team Name:_______________________________ Team Contact ______________________________
Phone Number____________________ E-mail______________________________________________
Release of Liability: I, being the Player or Guardian of the player listed beside my signature, hereby give
approval to his/her participation in league activities including playing on the team listed on this sheet. I
clearly understand this is NOT a US Youth Soccer sanctioned league. I recognize the possibility of
serious injury to such player and assume all risks and hazards related to such league participation. I
hereby release, discharge, absolve; and indemnify and agree to defend and hold harmless, Minot Soccer
Association, and its affiliates, sponsors, league sponsors, employees, coaches, representatives and
agents from and with respect to any claim, cause of action, liability, expense or obligation arising in
connection with, or related to, such players participation in the league and related activities. I hereby grant
permission to the team’s coaching staff, or league personnel, in my absence, to authorize and obtain
medical care and treatment from any licensed physician, nurses or medical personnel to the extent
deemed necessary by such physician, nurse or medical personnel and I assume full financial
responsibility for said treatment.
PLAYERS UNDER 18 require parent/guardian signature.
Player Name (Print)
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Player / Guardian Signature
Date