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REGISTRATION NUMBER

Parent/Guardian Information

Emergency Contact Information

Child Information

Player 1: All fields are mandatory

MaleFemale

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Player 2: All fields are mandatory

MaleFemale

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Player 3: All fields are mandatory

MaleFemale

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Player 4: All fields are mandatory

MaleFemale

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Player 5: All fields are mandatory

MaleFemale

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Player 6: All fields are mandatory

MaleFemale

PLEASE VERIFY THAT ALL INFORMATION ABOVE IS ACCURATE BEFORE PROCEEDING WITH PAYMENT

Payment Method:

I, the undersigned, as parent (or legal guardian) of the mentioned participant(s),indicate by legal signature below that I am in agreement with the following articles:

1) Said participant(s) is/are physically fit and permission is granted for his/her participation in the activities of Durham Islamic Soccer League.

2) If injured, participants will be taken to the nearest medical facility for treatment; unless I am present and personally take participants to another facility.

3) No Durham Islamic Soccer League director, officer, coach, volunteer or other official shall be held responsible for any injuries sustained to any participant in any Durham Islamic Soccer League activity.

4) All information provided will be used solely for the purpose of conducting the activities of Durham Islamic Soccer League.

5) I recognize my responsibility to behave in a sportsmanlike manner, and will encourage participants and others around me to do the same.

I have read, clearly understand and agree to the Durham Islamic Soccer League Risk Waiver and Consent Form.