Futsal Soccer League Team Roster
www.exeterfieldhouse.com
Phone: 610-779-6006
Fax: 610-779-6008
Please complete this form and return to Exeter Fieldhouse at/prior to the first scheduled game. Rosters are final after the 1st week.
Team Name:
Age Group:
Team Coach/Captain:
Coach/Captain Address:
Phone:
Email:
Assumption and release of liability: Participating in fitness programs and sports events are inherently dangerous. The Parent/Guardian hereby: (1) assume the risk of personal injury, property damage, or other loss to the Participant
arising from activities at Exeter Fieldhouse Sports and Performance Training Center (2) unconditionally waive, release, and discharge Exeter Fieldhouse Sports and Performance Training Center, and its agents, employees,directors,
partners from all liability for injuries to Participant; (3) release the Exeter Fieldhouse Sports and Performance Training Center from injury arising from any good faith acts or omissions in emergency situations and (5) permits the staff
of Exeter Fieldhouse Athletic Training Center to evaluate and treat my child, while participating in activities at Exeter Fieldhouse.
I agree that you may take pictures my child during my activities and that you allow you to use these images in future literature for Exeter Fieldhouse Athletic Training Center. I agree that in your testimonials you may use my name,
my child's name without limitation in advertising and promoting Exeter Fieldhouse Athletic Training Center.
I am over the age of 18 or a parent/guardian of the minor named above, and agree that my signature binds me and the participant of all of its terms.
Player Name (Print)
Team Coach/Captain Signature:
#
Date of Birth
Phone
Email
Parent/Guardian Signature
Date: