Illinois State Soccer Association Form A - Player Registration
Year: 2012
Please please complete and sign form. Please print all information clearly inside each box.
To the Registrar:
 Players Name (last name first):

 Players Status (professional or amateur):

 Club:

 Division:

 League:

 Email:

Last Registration:
 Club:

 Division:

 League:

 Year:

Player Information:
 Place of Birth:

 Date of Birth:

 Telephone:

 Address (Street, City, State, Zip):
New Player: Complete and sign form. Attach a copy of ID and one photograph.
Returning Player: Complete and sign form.
    Note: The player agrees to hold harmless the club, the league, the association and the federation in the event of any accidents involving the player while in uniform.

Note: US Amateur Soccer Association – Waiver and Release of Liability.
In consideration of being allowed to participate in any way in the US Amateur Soccer Association athletics/sports program, and related events and activities, the signed:
  1. Agree that prior to participating, they each inspect the facilities and equipment to be used, and if they believe anything is unsafe, they will immediately advise their coach or supervisor of such condition(s) and refuse to participate.
  2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions or negligence of others, the rules of play, or the conditions of the premises or of any equipment used.
  3. Assume all the foregoing risks and accepts personal responsibility for the damages following such injury, permanent disability or death.
  4. Release, waive, discharge and covenant not to sue the US Amateur Soccer Association, its affiliates and clubs, their respective administrators, directors, agents, coaches, and other employees or volunteers of the organization, other participants, sponsor agencies, sponsors, advertisers, and if applicable, owners and leasers of premises used to conduct the event, all of which are heinafter referred to as “releasees”, from demands, losses or damages on account of injury, including death or damage to property caused or alleged to be caused in whole or part by the negligence of the releasee or otherwise.
 Player's Signature: Club Officer Signature:
Penalty $1,000.00 for forgery of player signature