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Team Name:
_________________________________ Club Name ___________________________
State Affiliation:
(e.g.
CYSA-N)_______________________ League:
(e.g. CSL)_______________________
2006-2007 Age:
U-______ Girls___ Boys___ Oldest Player Born After July 31,
20_____
Level: Gold
(Premier)___ Silver Elite___ Silver___ Bronze___ Other
(e.g.
All-Star)__________
Team Contact
_____________________________________ Coach: _____ Manager: _____
Phone
#:___________________ Cell #: ____________________
E-Mail:_____________________
(To be accepted, teams must provide an e-mail address)
Street/City/St/Zip:
__________________________________________________________________
| Past Performance |
(last 12 months) |
League: |
Wins___ |
Losses___ |
Ties___ |
Place___ |
| State Cup: |
National___ |
Open___ |
Wins___ |
Losses___ |
Ties___ |
Finish___ |
| Tourney ___________________________________ |
Wins___ |
Losses___ |
Ties___ |
Finish___ |
| Tourney ___________________________________ |
Wins___ |
Losses___ |
Ties___ |
Finish___ |
| Tourney ___________________________________ |
Wins___ |
Losses___ |
Ties___ |
Finish___ |
Please list
any special requests such as playing times, multiple teams with
same trainer/coach, etc.
___________________________________________________________________________________
Waiver
of Liability
If accepted, we agree to release, hold harmless
and indemnify the Football Club of Santa Barbara Untied (FCSB),
its Board of Directors, members, officials, coaches, referees,
sponsors and their employees, agents, officers and directors
from any and all liability for injury, or damage to persons,
property, or economic interests connected with or arising out
of any action taken by them in good faith or out of any failure
by them to act. In the event of inclement weather or other
force of Nature, FCSB shall be the sole and exclusive judge
of whether the tournament shall be held, canceled, continued
or postponed and we hereby release FCSB and all the persons
or entities mentioned above from any and all liability for
direct or consequential damages resulting from the exercise
by them of such judgment. We understand that there will be
no refund compensation for lost games due to weather, forfeitures,
or acts of Nature as determined by the Tournament Committee.
As the representative of this team, I certify that the above
information is accurate and that each player registered to
participate in the tournament is covered by an approved medical
insurance plan as required by CYSA-S and FCSB. It is understood
that after acceptance, any and all refunds are at the sole
discretion of the Tournament Committee. We further understand
and agree that all age brackets will be played under the 2006-2007
playing year age designations.
Signed
by:________________________________________________ Date:______________
(Registered Team Coach or Club Official Only)
Mail
To: Brian Hersh, 379 Princeton Avenue, Santa Barbara CA 93111
Please Complete and Return with the preliminary Player Roster
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