Individual Player Registration

Free Agent Futsal League 2024/25

Option:  

Required  Price: $175.00
Description: Free Agent 11 games
 = Required Field

 Futsal League Free Agent

 
 
 
 
  Select Month/Day/Year
 
 Emergency Contact 
 Emergency # 
Comments 
 I am interested in participating in league play   Yes
   No


 Approvals

I, the parent/guardian of the above named Registrant, in consideration of accepting the Registrant for their soccer and/or futsal programs and activities (collectively the “Programs”) and recognizing the risk of potentially significant physical injury occurring by participation in the Programs, including permanent disability or death, for myself and Registrant, do knowingly and freely assume all such risks, both known and unknown, and assume full responsibility for the Registrants participation in the Programs. Further, I, for myself and Registrant, and on behalf of our respective heirs, assigns, personal representatives and next of kin, do hereby release, indemnify and hold harmless Brazilian Art Soccer Training, FutsalNH, its affiliated organizations and sponsors, and each of their employees, volunteers, agents, other participants, hosts, sponsors, advertisers, and the owners of the premises upon which the Programs are held (collectively, the "Releases"), with respect to any and all injury, disability, death, or loss or damage to person or property incident to Registrants participation in the Programs, and/or being transported to or from the same, which transportation I hereby authorize, and whether arising from the negligence of the Releases or otherwise, to the fullest extent permitted by law. I hereby warrant and represent that the Registrant has received a physical examination by a physician and has been found physically capable of participating in the Programs with no reservations or restrictions. I, for myself and Registrant, do hereby consent to have a doctor of medicine or dentistry, a licensed nurse or emergency technician provide Registrant with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY


I, the parent/guardian of the above named Registrant, in consideration for accepting the Registrant for their Soccer and/or Futsal programs and activities (collectively the “Programs”) hereby grants to FutsalNH the right and permission, free from approval, review, or cost, to photograph, record, or otherwise capture the Registrant's likeness in participating in the programs for use in media, now or hereafter known, including, but not limited to pictures and video, to copyright the same in its own name, and which may be included in whole or in part for commercial or promotional use.

 


 

COVID-19 WARNING AND DISCLAIMER:
COVID-19 is a contagious virus that spreads through person-to-person contact, and the contraction of the virus can lead to severe illness. Brazilian Art Soccer and Futsal NH's policies and procedures for players’ health and safety are based on State and CDC guidelines. However, Federal and state authorities recommend social distancing as a means to prevent the spread of the virus. Participating in Brazilian Art Soccer league play could increase the risk of contracting COVID-19. Brazilian Art Soccer and Futsal NH in no way warrants that COVID-19 infection will not occur through participation in the summer league.
In addition, I agree to follow the following procedures established by Brazilian Art Soccer and Futsal NH LLC
I will alert Brazilian Art Soccer and Futsal NH LLC if a player or anyone in the player’s household has potential symptoms of COVID-19, such as fever, shortness of breath or persistent dry cough, in the 72 hours prior to the start of a summer league game.
I will alert Brazilian Art Soccer and Futsal NH LLC if anyone in the player’s household is diagnosed with COVID-19.
I understand that league may need to close on short notice due to government order, child or staff illness, or other emergency.
I will take the player’s temperature before each week’s game and alert staff if the player has a fever (temperature of 100.4° or higher).
I understand if a player has taken any fever reducing medications such as acetaminophen or ibuprofen in the past 24 hours they may not play in the game.

 CONTACT INFORMATION

GUARDIAN #1

 
 STATE 
 ZIPCODE 
 1 of the 3 phone numbers below must be filled in
 HOME 
 WORK 
 CELL 
 PREFERENCE 
GUARDIAN #2 (optional)

 
 STATE 
 ZIPCODE 
 1 of the 3 phone numbers below must be filled in
 HOME 
 WORK 
 CELL 
 PREFERENCE 

 Refund Policy

Full refund if you request refund 10 days prior to event beginning. 

 Contact Info