All Star Soccer WAIVER AND RELEASE OF LIABILITY

Erie Premier Sports, Player’s Name:______

I understand that I am about to become a participant in a soccer program sponsored by Erie Premier Sports, LLC. I/we understand that there are certain risks of injury associated with playing soccer and I/we agree to assume those risks. I believe that I am in proper physical condition to participate in this sport. I understand further that it is my obligation to undergo a physical examination prior to participation in this sport to determine my fitness.

I hereby release and forever discharge Erie Premier Sports, LLC, its members, officers, coaches, and employees from any and all liability, including liability for antecedent negligence, for injury to my/our daughter/son by reason of her/his participation in the sport of soccer with Erie Premier Sports, LLC, the Boys & Girls Club of Erie, Harborcreek School District and the Erie Commodores. I understand that Erie Premier Sports, LLC is not providing any insurance if I sustain an injury, it will be solely my responsibility to provide and pay for any medical treatment required. I agree to indemnify and hold harmless Erie Premier Sports, LLC,the Boys & Girls Club of Erie, Harborcreek School District, the Erie Commodores , its members, officers, coaches, and employees from any and all liability they may occur on account of my participation in this program/event.

In the event of injury or illness, I authorize the coaches or other representative of Erie Premier Sports, LLC to arrange for and consent to, on my/our behalf, any required medical treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Dentistry or other licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures, and x-rays treatment.

I agree to indemnify and hold harmless Erie Premier Sports, the Boys & Girls Club of Erie, Harborcreek School District, the Erie Commodorestheir members, officers, and employees from any liability they may incur on account of my/our daughter’s/son’s participation in any practice or event.

I/we agree to hold harmless the committee, officers, employees, and volunteers from any

liability they may incur on account of my/our daughter’s/son’s participation in that particular tournament.

I have the following medical problems which should be noted:

My/our medical coverage company name is:

My/our policy number is:

In case of emergency, I/we can be reached at:

Father: Home# (______) Work# (______) Cell# (______)

Mother: Home# (______) Work# (______) Cell# (______)

Nearest friend or relative you can contact in an emergency should you be unable to reach me/us is:

Name: Phone: (______)

Family Physician: Phone: (______)

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 WITHOUT ANY INDUCEMENT.

______

(PARTICIPANT’S SIGNATURE) Date Signed

FOR PARTICIPANTS OF MINORITY AGE

(UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE.

Date Signed______

______

Parent/Guardian Signature Emergency Phone

PARENT EMAIL:______

Notice – By signing this document you will be waiving certain legal rights, including the right to sue.

Fee Paid______

Erie City - County

All Star Soccer Game Registration Form

Friday, August 4, 2017, Harborcreek High School, Erie, PA

Players Name:______

Field Position______

High School______

College/School Attending in Fall (if any)______

Field of Study______

Career Goals______

Player Address:______

Player Phone:______

Player Email:______

______

Participant fee is $20.00. Checks should be payable to Erie Premier Sports. Mail registration above and signed copy of the ATHLETIC WAIVER AND RELEASE OF LIABILITY FORM to Erie Premier Sports. Forms must be received no later than July 23rd. Players will be given a jersey for the game that is theirs to keep.

EVENT COORDINATOR:

Erie Premier Sports

4504 W. Ridge Rd.

Erie, PA 16506

(w) 833-0950

ALL STAR SOCCER Fact Sheet

Background on the All Star Soccer matches of recent years.

Honor to be chosen.

  • We’ve assembled the top talent of all the soccer players in the region.
  • You represent your school & your team
  • Play with integrity
  • This is a friendly but competitive game
  • We don’t want anyone to get hurt
  • Each player is recognized by name & their college/future plans announced

Girls and Boys Games and Time:

  • County in Red, City in Blue(sapphire)
  • Girls game at 6:30pm
  • Boys game at 8:00pm.
  • Harborcreek High School

History of the game

  • 1st two games went into double overtime
  • 1st year we had 350 fans, 2nd yr. 450, 3rd yr. 600+, 4th yr. 700, 5th 750, 6th & 7th 800
  • One of the biggest soccer matches in the entire region
  • We’re expecting over 1000+ fans
  • Excellent coverage from the Erie Times, WICU & all TV stations

Why we are playing

  • Charity event
  • Fundraiser for the Boys & Girls Club of Erie
  • Helps poor & disadvantaged kids a chance to participate in athletics
  • Money goes to Boys & Girls Club of Erie
  • In 10 years the All Star Soccer match has raised $30,000

Tell your Friends

  • Great event
  • $6 adults, $5 students, kids 8 & under are free
  • Impressive crowd
  • Each player is recognized by name at the beginning of the game
  • Second half is played under the big lights
  • Tell your parents, friends, aunts, uncles and cousins
  • Facebook all your friends
  • You are given a jersey to keep
  • Your name appears in the program

EVENT COORDINATOR:

Erie Premier Sports

4504 W. Ridge Rd.

Erie, PA 16506

833-0950