Team Name: ______________________________ Club Name ___________________________

State Affiliation: ___________________________ League: ______________________________

2003-2004 Age: U- ______ Girls ___ Boys ___ Oldest Player Born After July 31, 19 _______

Level: Gold (Premier) _____ Silver (AAA) _____ Bronze (AA-A) _____ Other _________

Team Contact _____________________________________ Coach: _____ Manager: _____

Phone #:___________________ E-Mail:_____________________ Fax #:_____________________
(To be accepted, teams must provide an e-mail address)

Street/City/St/Zip: __________________________________________________________________

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 2003-2004 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 Player Roster