Lancaster Goalkeeper Wars Waiver and Release Forms

ATHLETE INFORMATION

If you have more than one athlete, please fill out a seperate form and use unique emails for each.

I am filling this form to learn more about/register for *

Goalkeeper wars
Regular Goalkeeper Training
Regular Field Player Training

Choose all that apply

Athlete's Name *

First

Last

Nickname (OPTIONAL)

Date of Birth *

MM/DD/YYYY

Athlete's Sex *

Male
Female

In what category will your Goalkeeper be participating in? *

U8-U11
U12-U14
U15-18

Medical Information/Allergies *

Write none if not available

Health Insurance Provider *

Write none if not available

What is the athlete's shirt size? *

Youth
Adult

CONTACT INFORMATION

*If U18 (Parent or Guardian Information)

1 Parent/Guardian's Name *

First

Last

1 Relationship to Athlete *

Primary Cell Phone *

Number coaches can use for feedback, questions, and practice cancelations.

Can we text you? *

Primary Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Second Parent/Guardian (Optional)

I would like to add another parent/guardian? *

EMERGENCY INFORMATION

Emergency Contact's Name *

First

Last

Relationship to Athlete *

Phone *

Waivers

Please read the following statements, if you have read and accepted all the terms and conditions of Diamante Soccer Academy LLC's Lancaster Goalkeeper Wars, check "YES" and sign below.

Consent Agreement *

I, the minor's parent and/or legal guardian, understand the nature of soccer activities and the minor's experience and capabilities and believe the minor to be qualified, in good heath, and in proper physical condition to participate in such activity. I hereby release, discharge covenant not to sue, and gree to indemnify and save and hold harmless each of the realasee's from all liability claims, demand, losses, or damages or th

Emergency Treatment Release. *

PERMISSION IS HEREBY GRANTED TO DIAMANTE SOCCER ACADEMY LLC., and its affiliates including Trainers, Directors, Coaches, and Team Parents to who have the proper training to provide the needed emergency treatment before the athelete's admission to the medical facility.

Medical Release and Authorization *

I, Parent/Guardian, hereby authorize in my absence or unconsciousness the diagnosis and treatment by a qualified and licensed medical professional, of the athlete, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the athlete's life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Media Release and Confirmation *

I, Parent/Guardian of said athlete, grant permission to Diamante Soccer Academy LLC (DSA). Diamante Goalkeeper Academy (DGK), and Lancaster Goalkeeper Wars (LGW) and its agents and emplyeees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, recruitment, website, social media, and other forms of marketing and in any medium. I hereby release DSA, DGK, and LGW and its legal representatives for all claims and liability relating to said image or video. I waive my right to any compensation.

Please add me to your Quarterly Newsletters and keep me updated on future events, and camps. *