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REGISTRATION FORM

2023 NLT/Austin Sol/Player Combine Registration

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PLAYER   EXPERIENCE

HEALTH INSURANCE & EMERGENCY INFORMATION

MEDICAL TREATMENT & AUTHORIZATION & LIABILITY WAIVER

I hereby give my consent to have an athletic trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the participant with medical assistance and/or treatment and agree to be financially responsible for the cost of such service and/or treatment. I understand treatment for injury will be based on the information provided herein. I hereby authorize emergency transportation of the participant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with soccer, and hereby release, discharge, and otherwise indemnify the club, NLT, their sponsors, and its affiliated organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the soccer player named above as a result of that player’s participation in soccer programs and/or being transported to or from the same, which transporta􀆟tion I hereby authorize.

FOR MINORS ONLY (WAIVER & LIABILITY RELEASE FORM)

As the parent and natural guardian or legal guardian of                                                                         , I hereby forgo Waiver and Liability Release for and on behalf of the named herein. I hereby bind myself, the minor, and all other assigns to the terms of the Waiver and Liability Release. I represent that I have the legal capacity and authority to act for and on behalf of the minor in the execution of the Waiver and Liability Release.

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PLAYER   INFORMATION

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