Parent/Guardian Name *

First Name

Last Name

Player Name

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Checkbox *

Participant Waiver: * The parent or guardian agrees on behalf of their child and his/her heirs, executors, administrators and assigns, do hereby release 1v1 Futbol Dreams and its heirs, executors and assign from any and all liability for any injury or damage suffered by the child during or aspiring out of his/her participation in 1v1 Futbol Dreams. I assume the risk of any injuries that my child/wards may sustain while participating in any activity at the University of Winnipeg and Ralph Cantafio Soccer Complex. 1v1 Futbol Dreams uses photographs and videos to produce educational and marketing tools. Our photos and videos may be used in educational materials for athletes, posters and brochures and may be displayed in local soccer centers. Photos and videos may be kept on file for future use. I hereby give 1v1 Futbol Dreams permission to use (display, publish, etc.) any photographs or videos made of my child for all purposes, including educational, advertising and trade. If there are any media psychological or pharmacological conditions that would preclude this person from fully participating in all activities at 1v1 Futbol Dreams please specify inhibiting condition(s) in writing. BY SIGNING THIS WAIVER AND LIABILITY AGREEMENT I ACKKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND AND AGREE TO ALL OF ITS TERMS AND CONDITIONS.

I Agree

Media Release *

I hereby grant permission to 1V1 Futbol Dreams, hereinafter known as the “Media” to use my image (photographs and/or video and/or name/likeness) for use in any Media publications.