HALLOWEEN HAVOC OFFICIAL TEAM ROSTER FORM AND WAVIER/RELEASE OF LIABILITY TEAM INFORMATION: Team Name Age Division ________________________________________________________________________________ Team Contact Person Email Address ________________________________________________________________________________ Phone# Cell Phone # PLEASE READ BEFORE SIGNING of being allowed to participate In consideration in any way in the Halloween Havoc 3v3 tournament, related evets and activities (collectively, the Halloween Havoc 3v3 Tournament), the undersigning for himself/herself personal representatives, hair and next of kin. 1. Acknowledge appreciates, and agrees that the risk of injury form the activities involved in this event is significant, including the potential for injury, permeant paralysis and death. 2. KNOWINGLY AND FREELY ASSUME ALL SUCH RISK, both known & unknown, EVEN IF ARISING FROM NEGLIGENCE OF THE RELEASEES or others, & assumes full responsibly for my participation and 3. Willing agrees to comply w/stated & customary terms & conditions for participation. If however he/she observes any unusual significant hazard accruing his/her presence or participation, he/she will remove him/herself from participation &bring such to the attention of the nearest official immediately, and 4. Herby irrevocably grant Amarillo Soccer Association and its respective affiliates, subsidiaries, parents entitles, licensees, successors and assigns, and those acting with its permission or upon its authority (all of whom are referred to below as “licensed parties”) the absolute, perpetual, and unrestricted right & permission to record, copy, reproduce adapt, edit, summarize. Copyright, photograph, film, license. Vend, rent, distribute, televise, publish, exhibit, disseminate, preform& otherwise exploit in any& all markets and media (collectively “use”) his/her appearance, name, likeness, voice, documents, participation in the Halloween Havoc 3v3 Tournament. Other property, views, performance, efforts, trademark or trademark name, biography, artistry, recorded image, & voice, as well as all other documents and artifacts provided by ASA by him/her (collectively “the materials”.) This grant of rights is made without limitations upon time, circumstances, location, Market or medium of use & without any right to inspect or approve the materials of the uses to which any of the materials may be put & payment due to him/her, and 5. Agrees that all audio/or video recordings of the materials or any of them as well as all descriptions or summaries of his/her personal history & /or views that are made &used by any licensed party will be solely owned by ASA and that ASA may copyright its name & for its sole benefit any such audio or video recording of the Halloween Havoc 3v3 Tournament containing the materials or any of them, and 6. Acknowledges, appreciates, &agrees that he/she family, estate, heirs, & or assigns; and 7. HEREBY INDEMNIFIELS, RELEASEM AND HOLDS HARMLESS Amarillo Soccer Association, North Texas State Soccer Association, and the city of Amarillo. Its affiliates, subsidiaries, & parents’ entities, & their officers, officials, agents, &/or employees’, director’s, shareholder’s other participants, sponsoring agencies, sponsors, advertisers, & if applicable owners, & lessors of premises used to conduct the Halloween Havoc 3v3 Tournament (“Releases”) WITH RESPECT TO ANY AND ALL INJURY, DISABLILITY, DEATH, or loss of damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASESS OR OTHERWISE: and 8. HAS READ THIS RELEASE OF LIABLILITY & ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND THAT HE/SHE HAVE GIVEN UP THE SUBSTANTIAL RIGHRTS BY SIGNING IT. AND DOING IT FREELY & VOLUNTARILY WITHOUT ANY INDUCEMENT and authorize on he/she behalf any of the Releases to obtain any medical care or treatment deemed necessary: and 9. Warrants the represents that he/she is the owner of all rights granted hereunder or has been duly authorized by the owners such rights to grant the same and is at least 18 years of age or is the legal parent or gradian of the minor child listed below and is executing this WAIVER/RELEASE OF LIBALITY/REFUND POLICY/BAD WEATHER POLICY on behalf of such minor child. In the event that the Undersigned is a legal parent or guardian of a minor child who turn the age of 18 during the Halloween Havoc 3v3 Tournament, the acknowledge and agreement of such a child is required. There will be no refunds granted for any reason before or after the registration deadline. This includes but is not limited to 1) Your team’s inability to participate due to player injury, personal schedule or game scheduling conflicts, team drama or other reasons: 2) inclement weather, etc. In case of inclement weather, the Halloween Havoc 3v3 Tournament Director reserves the right to reduce the number of scheduled games&/or the time of games &/or postpone or delay game times and/or cancel the Halloween Havoc 3v3 Tournament. Every effort will be made to complete games and the tournament. Entry fees are non-refundable after registration deadlines. ***Players may sign if over the age of 18 Roster Sheet Halloween Havoc 3v3 Torment Players Full Name Date of Birth Email Address Signature of Shirt Size Parent/Guardian or Player if over 18 TEAM CONTACT/COACHES VERIFICATION: This is to certify that this roster does not include any assumed names and that each player conforms to eligibility rule governing the Halloween Havoc 3v3 Tournament. _________________________________________________________________________________________________________________________ Coach/Team Contact Signature Date Print Name OFFICE USE ONLY Received By: __________________________ Date:________________ Team Birthdates verified by: _______________ Age Division: __________ .