La Finca Player Waiver

Player First

Player Last

Player Date of birth

Parent/Guardian Email

Phone

Home City/Town

Player Medical Concerns, write N/A if none

RELEASE OF LIABILITY -- READ BEFORE SIGNING

By signing below, I, as the parent/guardian of the registrant, hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may given under whatever conditions are necessary to preserve the life, limb, or well-being of registrant. By submitting the form, I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of La Finca, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for La Finca, accepting the registrant for its soccer programs and activities (the "Programs"). I hereby release, discharge and/or otherwise indemnify La Finca, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claimby or on behalf of the registrant as a result of the registrant's participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.

Signature

MEDIA RELEASE -- READ BEFORE SIGNING

I hereby grant the La Finca permission to use my likeness in a photograph, video, or other digital media (“photo”) created in the course of any of their programs I participate in, in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of La Finca and will not be returned.I hereby irrevocably authorize the La Finca to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo.I hereby hold harmless, release, and forever discharge the La Finca from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE MEDIA RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW. I ACCEPT:

Signature