Player Interest Form

Participation Waiver

Program Waiver Acceptance

I, the parent/legal guardian, of the player, a minor, agree that I and the player will abide by the rules and regulations of the Santa Cruz Breakers Academy (Breakers FC), MLS Elite Youth Development Platform, U.S. Club Soccer and U.S. Youth Soccer (USYS), and their affiliated organizations, and the California Youth Soccer Association, Inc (CYSA), and its affiliated organizations. I, for myself and the player and our respective heirs, administrators and successors, intending to be legally bound, hereby release and indemnify the Santa Cruz Breakers Academy (Breakers FC), MLS Elite Youth Development Platform, US Club Soccer, USYS and CYSA Parties, the owners and operators of the facilities used for the Programs, and their respective directors, officers, employees, agents, and representatives from and against all claims, liabilities, damages, or causes of action arising out of or in connection with the player’s participation in the Programs including, without limitation, player’s transportation to/from any Program, which transportation is hereby authorized. I further grant the Santa Cruz Breakers Academy (Breakers FC), MLS Elite Youth Development Platform, US Club Soccer, USYS and CYSA Parties the right to use player’s name, picture and /or likeness in printed, broadcast and other material concerning the Programs provided such use is related to the player’s status as a participant in the Programs.

Consent for Medical Treatment (Minor)

As the parent/legal guardian of the player, I hereby give consent for medical care prescribed by duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve life, limb, or well-being of my dependent. *

COVID-19 RELEASE OF LIABILITY FOR MINOR PARTICIPANTS - READ BEFORE SIGNING CONSENT BELOW

IN CONSIDERATION OF my player (child or ward named in this registration) being allowed to participate in any way in Santa Cruz Breakers Academy (Breakers FC)-related events and activities, the undersigned acknowledges, appreciates, and
agrees that:
The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) to my child from the activities involved in these programs are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and,

1. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and
unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility
for my child’s participation; and,
2. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any
unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from
the participation and bring such attention of the nearest official immediately; and,
3. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY
RELEASE AND HOLD HARMLESS Santa Cruz Breakers Academy (Breakers FC); its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY,
DEATH, or loss or damage to person or property incident to my player’s (child or ward's) involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent
permitted by law.
4. I, for myself, my spouse, my player (child or ward), and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my
involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent
permitted by law.
5. I, the parent/guardian, assert that I have explained to my player/child/ward: the risks of the activity, his/her responsibilities for
adhering to the rules and regulations, and that my child/ward understands this agreement. I, FOR MYSELF, MY SPOUSE, AND PLAYER/CHILD/WARD, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.