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Waiver

2015-2016 Season Waiver

Please complete the following waiver for all classes and leagues at The Soccer Learning Center.

ALL FIELDS need to be completed on this waiver.  If you submit an incomplete waiver, you will be prohibited from playing until a fully completed waiver is submitted.  

Questions?  Kindly contact our office at 201-656-1156.

ALL FIELDS MUST BE COMPLETED ON THIS WAIVER - THANK YOU

Player's Name*

Class or League Selection*

League Team Name (If Known)*

Mailing Address*

City*

State*

Zip Code*

Occupation*

Email Address*

Alternate Email Address

Home Phone*

Work Phone*

Cell Phone*

Emergency Contact Name*

Emergency Contact Phone*

Do you have ANY medical condition or allergy that we need to know about, particularly any condition that may impede breathing (like asthma, food allergies, reactions to bug bites, etc)?*
Yes No 

Are you required to take ANY type of over-the-counter or prescription medication, including but not limited to inhalers, breathing treatments, or rescue-aids like an epi pen?*
Yes No 

TSLC Individual Player Waiver/Release:*

By entering my initials below, I certify I am the above registered player who wishes to participate in soccer related activities at The Soccer Learning Center (referred to as Activity). I have disclosed any pertinent medical information in this document and certify that I have been cleared by my healthcare provider to participate in The Soccer Learning Center Activity. I also certify that I am of the required class age and understand that if I do not produce documents verifying my age, I will be removed from class and I will forfeit 100% of my tuition.

I acknowledge that the nature of the classes at The Soccer Learning Center may expose me to hazards or risks that may result in illness or personal injury. I understand and appreciate the nature of such hazards and risks. In consideration of my participation in the Activity, I hereby accept all risk to my health and of my injury that may result in such participation and I hereby release Team Raja, LLC DBA The Soccer Learning Center, it officers, employees, and representatives from any liability to me, our personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to our property and for any and all illness or injury to me that may result from or occur during my participation in the Activity, whether caused by negligence of Team Raja, LLC, its officers, employees or representatives or otherwise. I further agree to indemnify and hold harmless Team Raja, LLC, its officers, employees, and representatives from liability for the injury of any person(s) and damage to property that may result from my negligent or intentional act or omission while I participate in the described Activity.

I understand that NO ALCOHOL, ILLICIT DRUGS OR CONTROLLED SUBSTANCES OF ANY KIND (OTHER THAN THOSE THAT ARE LEGALLY PRESCRIBED BY A PHYSICIAN) CAN BE CONSUMED ON THE PREMISES, INCLUDING IN THE COMMON AREAS OF THE LOCATION WHICH INCLUDE THE LOBBY, RESTROOMS AND PARKING LOT AREAS. IF ANY PLAYER IS SUSPECTED OF BEING UNDER THE INFLUENCE OF ALCOHOL OR ILLICIT DRUGS OR IS SEEN CONSUMING ALCOHOL OR ILLICIT DRUGS, THEY WILL BE REMOVED FROM THE PREMISES AND RISK EXPULSION/TEAM ELIMINATION FROM THE SOCCER LEARNING CENTER WITHOUT A FEE OR TUITION REFUND.

I understand that children of any age are not permitted to accompany me to any TSLC Activity and that bringing a child to my Activity will expose them to danger or injury. I hereby release Team Raja, LLC DBA The Soccer Learning Center, it officers, employees, and representatives from any liability to me or any child or guest, our personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to our property and for any and all illness or injury to me, any child or guest that may result from or occur during my participation in the Activity, whether caused by negligence of Team Raja, LLC, its officers, employees or representatives or otherwise. I further agree to indemnify and hold harmless Team Raja, LLC, its officers, employees, and representatives from liability for the injury of any person(s) and damage to property that may result from my negligent or intentional act or omission while I participate in the described Activity.

I understand that once I register for this Activity, I have reserved a space that is non-refundable.

I certify that I have also read, understand and agree to abide by the POLICIES of The Soccer Learning Center.

Player's Initials*

Date (mm/dd/yyyy)*