EMPIRE        SOCCER        LEAGUE

                        PLAYER  REGISTRATION   APPLICATION

                                  TEMPORADA  2012-2013

 

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                                                    FIRST NAME        (NOMBRE)                        LAST NAME   (APELLIDO)

 

 

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                                                                     ADDRESS      (DIRECCION  CALLE)

               NEED  ONE

               PICTURE

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                                                                           CITY  (CIUDAD)                                                   ZIP CODE

                NECESITA

               UNA FOTO

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                                                     # DE TEL (TELEFONO)                  DOB (FECHA DE NAC.)                   SEX

 

 

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                                                 TEAM NAME (NOMBRE EQUIPO)                         FECHA(DATE)                       DIV

 

                        CERTIFICACION:DOY CONSENTIMIENTO PARA QUE EN CASO DE NESECITAR AYUDA MEDICA

                      EN EL CAMPO DE JUEGO Y, O, ENTRENAMIENTO SE ME OTORGUE.

                      SIN QUE YO TENGA QUE BUSCAR RESPONSABLES EN LA LIGA, O EN LOS DIRECTIVOS DE LA MISMA,

                      CUALQUIER DEMANDA JUDICIAL,,CIVIL O DE CUALQUIER TIPO LOS DIRECTIVOS DE LA LIGA NO SON

                      RESPONSABLES DE LA MISMA Y SOLO SERA EN CASO DE EXISTIR, PARA CUBRIR GASTOS MEDICOS

                      QUE EN EL CAMPO DE JUEGO SE OCACIONEN. SIEMPRE Y CUANDO NO EXEDAN LOS LIMITES DE LA

                      COBERTURA TOTAL DE LA ASEGURANZA EN TURNO.

 

                        CERTIFICACION: I GIVE CONSENT SO THAT IN CASE OF MEDICAL HELP

                      IN THE PLAYING FIELD AND, OR, TRAINING BE OFFERED TO ME.  ANY LEGAL ACTION, CIVIL  OR OF

                      ANY TYPE, THE EXECUTIVES OF THE LEAGUE ARE NOT RESPONSIBLE FOR THE SAME AND

                      OR ANY MEDICAL ACTION, IN CASE TO EXIST, TO COVER MEDICAL EXPENSES THAT IN THE PLAYING

                      FIELD APPEARS.  WHENEVER NOT EXCEED LIMIT OF THE TOTAL COVER OF THE INSURANCE IN SHIFT. 

                      EMPIRE SOCCER LEAGUE IS NOT RESPONSIBLE. OF EXPENSES THAT ITSELF EXCEEDS OF THE LIMIT

                      OF  THE TOTAL COVERAGE.  

 

 

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                        PLAYER SIGNATURE  (FIRMA     DEL JUGADOR)        PERENT SIGNATURE (FIRMA DE PADRES)IF NEED

 

 

                      INFORMACION GENERAL:    www.empiresoccerleague.com