Hispanic Heritage Month Kick-Off

CopaKansas 2010:
Torneo estatal de Futbol Latino
Medical Release Liability

Athletic Acknowledgement and Release I agree to terms under this “Consent and Release Certificate” and know of no
reason why I am not eligible to represent my team in athletic competition. I agree to follow the rules of the soccer
tournament (referred to as “Copa Kansas”) and to abide by applicable decisions. I know of the risks involved in the sport of
soccer, I understand that serious injury, and even death, is possible in such participation, and choose to accept such risks. I
voluntarily accept any and all responsibility for my own safety and welfare while participating in Copa Kansas, with full
understanding of the risks involved. Should I be 18 years of age or older, or emancipated from my parent(s) or guardian(s), I
hold harmless my team, the teams against which it competes, the contest officials and any and all responsibility and liability
for any injury or claim resulting from such athletic participation and agree to take no legal action because of any accident or
mishap involving my athletic participation. I must display good sportsmanship and follow the rules of competition before,
during and after every contest in which I participate. If not, I may be suspended from participation. I also agree to strictly
comply with a “no-tolerance” policy in which no fighting will be accepted & any fighting will result in immediate
disciplinary action of disqualification and indefinite suspension from duration of tournaments. Furthermore, I grant the
released parties the right to photograph and/or videotape me and further to use my name, face, likeness, voice and
appearance in connection with exhibitions, publicity, advertising, promotional and commercial materials without
reservation or limitation. The released parties, however, are under no obligation to exercise said rights herein. Should I be
under 18 years of age, I agree to the terms as outlined in this release and understand I must have signed consent by my
parent(s) or guardian(s) to participate in the Copa Kansas event.

Medical Release: In consideration for the acceptance of the application by “Copa Kansas” or any tournament sponsors, and with full
knowledge and recognition for the dangers and hazards inherent in participation in such activity which may include sprains, lacerations,
concussions, broken bones, concussions or death, I do hereby agree to assume all the risks and responsibilities surrounding applicant’s
participation in soccer tournament; and further I do hereby agree for the applicant, by his or his/her heirs and personal representatives,
to defend, hold harmless, indemnify; release and forever discharge of “Copa Kansas” and any tournament sponsors, its officers, agents
and employees from and against any and all claims, demands, actions or causes of action of, and without fault and negligence. We
recommend participants get a physical exam prior to tournament and in the event of injury or illness, tournament staff and sponsors are
authorized to obtain care or treatment if necessary.
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I HAVE READ THIS CAREFULLY AND KNOW IT CONTAINS A RELEASE.

PARTICIPATING ATHLETE PARENT OR LEGAL GUARDIAN

1. Signature: ___________________ Date: _________ Signature: _________________________________

Name (printed):______________________________ Date: ________________

2. Signature: ___________________Date: __________ Signature: ________________________________

Name (printed):______________________________ Date: ________________

3. Signature: ___________________ Date: _________ Signature: _________________________________

 Name (printed):______________________________ Date: ________________

4. Signature: ___________________Date: __________ Signature: ________________________________

Name (printed):______________________________ Date: ________________

5. Signature: ___________________ Date: _________ Signature: _________________________________

Name (printed):______________________________ Date: ________________

6. Signature: ___________________Date: __________ Signature: ________________________________

Name (printed):______________________________ Date: ________________

7. Signature: ___________________ Date: _________ Signature: _________________________________

Name (printed):______________________________ Date: ________________

8. Signature: ___________________Date: __________ Signature: ________________________________

Name (printed):______________________________ Date: ________________

9. Signature: ___________________ Date: __________ Signature: ________________________________

Name (printed):_______________________________ Date: ________________

10. Signature: _________________ Date: ___________ Signature: ________________________________

Name (printed):_______________________________ Date: ________________

11. Signature: __________________ Date: __________ Signature: ________________________________

Name (printed):_______________________________ Date: ________________

12. Signature: ___________________Date: __________ Signature: ________________________________

Name (printed):_______________________________ Date: ________________

13. Signature: ___________________ Date: _________ Signature:_________________________________

Name (printed):_______________________________ Date: ________________

14. Signature: ___________________Date: __________ Signature: ________________________________

Name (printed):_______________________________ Date: ________________

15. Signature: ___________________ Date: __________ Signature: ________________________________

Name (printed):_______________________________ Date: ________________

16. Signature: ___________________ Date: __________ Signature: ________________________________

Name (printed):________________________________ Date: ________________

17. Signature: ____________________ Date: _________ Signature: ________________________________

Name (printed):________________________________ Date: ________________

18. Signature: ____________________ Date: _________ Signature: ________________________________

Name (printed):________________________________ Date: ________________

TEAM NAME: _______________________________________________________________________

 Hispanic Heritage Month Kick-Off

CopaKansas 2010:
Torneo estatal de Futbol Latino
Copa Kansas / Team Roster

EQUIPO/TEAM NAME_________________________
Cuidad/Liga: __________________________________
Coach/Entrenador: _____________________________
Telephone # Teléfono: ___________________________

1 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

2 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

3 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

4 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

5 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

6 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

7 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

8 Name Name/Nombre: ___________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

9 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

10 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

11 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

12 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

13 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

14 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

15 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

16 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

17 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________

18 Name/Nombre: ________________________________________ Number/Numero: __________

Signature/Firma: _______________________________________ Date/Fecha: _______________