Achievement+ Perspective+ Perseverance

WEST SIDE ALLIANCE

SOCCER CLUB

VERIFICATION & MEDICAL TREATMENT AUTHORIZATION

REGISTRATION VERIFICATION

BY CHECKING BELOW, I hereby consent to West Side Alliance Soccer Club registering me with US Club Soccer.  I understand that I may be registered to only one US Club Soccer member club at any time.  I understand this is a one-year commitment. 

MEDICAL TREATMENT AUTHORIZATION

BY CHECKING BELOW, I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the applicant/participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment.  I understand treatment for the injury will be based on information provided herein.  I hereby authorize emergency transportation of the applicant/participant to a medical treatment facility should an individual listed above consider it to be warranted.  I recognize the possibility of physical injury associated with soccer, and thereby release, discharge, and otherwise indemnify the WSA Soccer club, US Club Soccer, their sponsors, the USSF and its affiliated organizations, and the employees and contractors and associated personnel of these organizations, against any claim by or on behalf of the soccer player named above as a result of that player's participation in WSA Soccer and US Club Soccer programs and/or being transported to or from the same, which transportation I hereby authorize.