LEG-A-Z SOCCER ACADEMY

2009-2010 Competitive Youth Soccer Tryouts     Boys and Girls Teams

Technical Director: Basil Benjamin, USSF A License, FA International License

PARENT/GUARDIAN APPROVAL: In consideration of the acceptance of my child or ward to participate in the soccer program offered by Leg-A-Z Sports Academy, Inc., I agree, on behalf of my child or ward, to assume the risks incidental to such participation (which may include, among other things, muscle injuries and broken bones) and, on my own behalf, and on behalf of my child or ward, and on behalf of me and my child’s or ward’s heirs, executor and administrators, release and forever discharge Leg-A-Z Sports Academy, Inc., its officers and its agents, of and from all liabilities, claims, actions, damages, costs or expenses of any nature arising out of or in any way connected with the participation of my child or ward in such activity, and further agree to indemnify and hold Leg-A-Z Sports Academy, Inc., its officers and its agents harmless against any and or all such liabilities, claims, actions, damages, costs or expenses, including, but not limited to, attorney’s fees and disbursements. I understand that this release and indemnity agreement includes any claims based on the negligence, action or inaction of any officers or agents of Leg-A-Z Sports Academy, Inc., and covers bodily injury (including death) and property damages, whether suffered by my child or ward, before, during, or after such participation. I declare that my child is physically fit and has the skill level required to participate in the activities of the Leg-A-Z Sports Academy, Inc. I further authorize medical treatment of my child or ward, at my cost, if the need arises.

Signature of Parent/Guardian: ___________________________________________________ Date: _________

Please Print Plainly

PLAYER NAME (last, first, MI): _______________________________________________________________

 DOB: ______/______/_____   Gender:   M     F   Age Group:  u10   u11   u12   u13   u14   u15   u16   u17   u18

PARENT/GUARDIAN NAME:_____________________________________________________________

ADDRESS: ____________________________________________ CITY: _____________ , FL __________ (zip)

PHONE: (home) (______) ______________________ (work) (______)__________________  (cell) (______)________________________

EMAIL1:______________________________________________________________________________________________

EMAIL2:______________________________________________________________________________________________

P.O. Box 141656  Gainesville, FL 32614  Phone: (352) 377-6088 e-mail: khunum@legazsoccer.com

For more than 16 years, Leg-A-Z Soccer has provided high-level coaching in a player-friendly environment. Area players who have participated in Leg-A-Z teams and camps are those who have had the most success in high school and college. Leg-A-Z has produced more players of the year, all-state players, ODP players and all-area players than any other single group of its kind in the area. Our unique integration of skill and tactical understanding contributes greatly to our players’ success. For more details, visit www.legazsoccer.com. Can’t make tryouts? A tryout can be arranged at Leg-A-Z’s summer camps. Visit the legazsoccer.com website, or call Basil at 377-6088, for arrangements.

Wear white T-shirt, cleats, shin guards  Bring ball, water, and this form