HSU Soccer 6v6 Tournament

HSU 6v6 SoccerTournament2012 6v6 Soccer Tournament will take place March 31st 2012 at Humboldt State University. This is an open tournament allowing any player the opportunity to compete. Guaranteed AT LEAST 3 GAMES.

THErE wiLL bE A MEnS And woMEnS brAckET. (no co-Ed)

The cost is $100 per team

To make communication as easy as possible, each team will have a captain. This person will act as the go between.

To register, the Team Application and FULL payment is required. Each player must fill out a copy of the waiver and the Team captain must return all forms together as a complete team packet to:

HSU Student Financial Services 1 Harpst Street Arcata, c.A. 95521 (Make checks payable to Humboldt State University)

And, send conformation EMAiL to roland demombynes

Check In: Team check in will be at 8:30am on March 31st.

check in will be at the new college creek Soccer Field. Games will be at college creek & redwood bowl

Questions? Contact Roland Demombynes at

rng4@humboldt.edu.(206)384-5530

March 31st 2012 (registration MUST be recieved by March 23rd 2012)

~ Full Payment, Team Application, and all waivers ~

Mens & womens 6v6 Tournament(5 Field Players + 1 Goalkeeper)

Check out www.hsujacks.com for all the latest news about our program!

Captainss Name: Other Teammates:

Team Name:

Phone:

Email:

Team Application

ASSUMPTION OF RISK/HEALTH STATEMENT/LIABILITY WAIVERNOTICE: This waiver is a contract with legal consequences. Read it carefully before signing! If there are any questions concerning thisdocument, contact the sport camp coordinator.In consideration of my son/daughter to participate in the Soccer Sport Camp, I hereby freely agree to make the following contractual agreements: Inagreeing to allow my son/daughter to participate in the Soccer Sport Camp at Humboldt State University, I am aware and knowledgeable of the risksof this activity, and other risks and dangers which may occur, including but not limited to hazards of travel, acts of God, accident, illness, physicaland/or psychological injury, property loss, temporary or permanent disability, or even death. I understand and agree that my son/daughter may be insituations that may arise during an activity which may be beyond control. I fully realize the dangers of my son/daughter participating in an activityof this type and voluntarily assume all the risks associated with such participation. In consideration of my son/daughters acceptance as a participantin such sport camp, I hereby release, forever discharge and agree to hold harmless the State of California, California State University, HumboldtState University, Redwood Conference Center, Lumberjack Enterprises, its offi cers, employees and agents from any and all liability, claims, suits ordamages, including attorneys fees resulting from my son/daughters participation in the sport camp. This contract shall serve to indemnify the abovenamed parties should the same be liable or found negligent as a result of any court action arising from my son/daughters participation in the SoccerSport Camp.I HAVE READ AND UNDERSTAND (INITIAL HERE) _____I agree that it is my sole responsibility to be familiar with the physical and/or mental demands associated with the above named camp. With thesedemands in mind, to my knowledge, my son/daughter, does not have a physical or medical condition which would endanger him/her or others dueto his/her participation in this activity, or would interfere with his/her ability to participate in the activity. I understand that the Soccer Sport Campat Humboldt State University has not made, nor will make any investigation into the participants physical fi tness or the ability of the participant toparticipate in the activity and is relying on my representation concerning the participants physical and mental condition. I also agree that my son/daughter will abide by any established rules or regulations while participating in this activity.I HAVE READ AND UNDERSTAND (INITIAL HERE) _____I hereby declare that my son/daughter is physically capable to be a member of and participate in the Soccer Sport Camp at Humboldt State Univer-sity.Furthermore, in the event of accident or illness of an emergency nature, and because I may be unable to select or approve of the required medicaltreatment, I do hereby authorize the organizations offi cers, event organizers or representatives of HSU to arrange for such care as is available andnecessary: and do further release and forever discharge the providers of such care and the State of California, California State University, HumboldtState University, Redwood Conference Center, Lumberjack Enterprises, its offi cers, employers and agents from any and all claims, demands andcauses of action arising out of said authorization.I HAVE READ AND UNDERSTAND (INITIAL HERE) _____Please list any physical disabilities, conditions, past injuries or any other physical limitations which could limit your son/daughters participation inany way. (If there is any doubt whatsoever about your childs ability to safely participate in this activity, he/she should have a physical examinationby a physician).Please list any allergies or medical alert information: _____________________________________________________________________________________________________________________________________________________________________________In case of emergency notify: ___________________________________________Home phone: ____________________ Work phone:____________________Insurance Carrier: ________________________________________________________________Policy #: ____________________________________________________________I am aware that Humboldt State University does not provide medical insurance coverage and therefore take full responsibility for my childs medicalinsurance and/or costs of medical treatment. I understand that all expenses, charges, or costs which might result from injury or illness are fully myresponsibility.I HAVE READ AND UNDERSTAND (INITIAL HERE) _____I have carefully read this form and understand its contents. I am aware this is an assumption of risk, a health statement and a liability waiver. It is anagreement not to sue for negligence and a contract between myself and the Soccer Sport Camp. I also hereby acknowledge that this agreement shallbe governed and construed in accordance with California law and each party hereby irrevocably submits to the exclusive jurisdiction and service ofprocess of the California courts. I further acknowledge that I am 18 years or older and am the parent or legal guardian of the participant for the benefit of others described herein. I sign it of my own free will.

I HAVE READ AND UNDERSTAND (INITIAL HERE) _____Participants name_____________________________________________________Parent/Guardian signature ___________________________ Date _______________Participants signature (if over 18) _____________________ Date _______________ NST-ATH J163