Player’s Name ___________________________________________Age ___________

Date Of Birth ________________School __________________________ Grade ______

Player (or Parent) E-Mail Address _____________________________

Parent’s Name(s)_______________________________________________________

Address _______________________________________ Player resides with ________

City __________________________ State ___________ Zip ___________

Phone # ____________________________

By signing this waiver I understand that my child is trying out for a select soccer club. As such, there is no guarantee that my child will be placed on a team. I understand that all decisions regarding placement on a team are made at the sole discretion of the LASSO club officials. Further, I agree to hold harmless the LASSO soccer club, and all LASSO officials, directors, agents and representatives for all decisions regarding team placement.

I also agree to hold harmless the LASSO soccer club and all LASSO officials, directors, agents and representatives for any injuries or mishaps that may occur during the period of time which tryouts are held. I understand my presence is required for the entire tryout period in the event of medical emergency.

Parent or Guardian Signature ________________________________ Date __________

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Last Update:  June 7, 2006

Lowell Area Select Soccer Organization
Lowell, Michigan, U.S.A.