TEAM NAME _____________________________ LEAGUE ____________________

AGE GROUP______PLAYERS NAME______________________________________

DATE OF BIRTH ____________________

ADDRESS ___________________________________________________________

CITY ______________________________________________ ZIP________________

PHONE (H) ___________________________ (W)_____________________________

GSYSA ID NO. ______________________E-MAIL _____________________________

                                (YOUTH ONLY)

AGREEMENT WAIVER OF LIABILITY

I, _________________________________________OF_____________________AS A

PATRON OF SOCCER UNITED, INC. (HEREINAFTER REFERRED TO AS SOCCER ACADEMY) LOCATED AT 327 ARCADO ROAD, LILBURN, GEORGIA, STATE THAT I AND/OR MY CHILD WILL ENGAGE IN ANY NUMBER OF SPORTING ACTIVITIES AT THE SOCCER ACADEMY, INCLUDING, BUT NOT LIMITED TO, INDOOR SOCCER, OUTDOOR SOCCER AND OTHER SPORT ACTIVITIES.

I HAVE INSPECTED THE PREMISES AND I KNOW THE RISKS AND DANGERS OF PARTICIPATION IN SUCH ACTIVITIES, AND I AM AWARE THAT UNEXPECTED RISKS AND DANAGERS MAY ARISE INCIDENT TO PARTICIPATION IN THE ABOVE ACTIVITIES. IN CONSIDERATION OF PERMISSION TO USE THE PREMISES, I FOR MYSELF AND FOR MY CHILD ASSUME ALL RISKS INCIDENT TO PARTICIPATION IN THE ABOVE ACITVITIES AND RISK INCIDENT TO BEING ON THE PREMISES FOR ANY REASON.

IN EXCHANGE FOR PERMISSION GRANTED TO MYSELF AND /OR MY CHILD TO ENTER AND USE THE PREMISES, I HEREBY, FOR MYSELF, MY CHILDREN, MY HEIRS AND ASSIGNS, AND MY CHILD’S HEIRS AND ASSIGNS WAIVER AND DISCHARGE THE SOCCER ACADEMY, SOCCER UNITED INC. AND ALL ITS EMPLOYEES, AGENTS, SUBCONTRACTORS, AND SUCCESSORS IN INTEREST AND HENRY E. DANIEL PERSONALLY FROM ALL CLAIMS, ACTIONS, OR CAUSE OF ACTION FOR INJURY SUSTAINED TO MINE OR MY CHILD’S PERSON OR PROPERTY DURING MINE OR MY CHILD’S PRESENCE ON THE PROPERTY REGARDLESS OF THE ACTIVITY ENGAGED IN. THIS WAIVER IS OPERATIVE REGARDLESS WHETHER INJURY WAS CAUSED BY NEGLIGENCE OR ANY OTHER FAULT.

IN THE EVENT THAT ANY PORTION OF THIS AREEMENT IS DECLARED VOID BY A COURT OF COMPETENT JURISDICTION, THE REMAINDER SHALL HAVE FULL FORCE AND EFFECT. THIS RELEASE AND WAIVER IS TO REMAIN IN EFFECT FOR A PERIOD OF THREE YEARS FROM THE SIGNING DATE BELOW.

I HAVE READ AND UNDERSTAND THE FOREGOING

IN WITNESS HEREOF, I HAVE EXECUTED THIS AGREEMENT THIS ______ DAY OF __________________, 20____.

_____________________________        ____________________________      _____