Team Contact Name
Team Contact Email
Team Medical Release
I hereby acknowledge that participation in soccer competition carries with it potential hazards. I, therefore, release Doug Miller 19 Inc. d/b/a Rochester Lancers and K&K Property Ventures LLC, it's team coaches, affiliates from any liability in the event of injury or illness suffered while playing for Rochester Lancers, Camps, Clinics, Training, League or Tournament games. Recognizing the possibility of injury associated with soccer and in consideration for the USSF/USYSA/US Club and its affiliates accepting the registrant for its soccer programs and activities, I hereby release, discharge, and/or otherwise indemnify the USSF/USYSA/US Club, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of the fields and facilities utilized for the Programs against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from same, which transportation I hereby authorize. My son/daughter has received a physical examination by a physician and has been found physically capable of participating in the Programs. I hereby give my consent to have an athletic trainer and/or doctor of medicine or dentistry provide my son/daughter with medical assistance and/or treatment.
I hereby waive and release any all rights to photography and video taken by Doug Miller 19 Inc. or K&K Property Ventures LLC during any Camps, Clinics, Training, League play or Tournament Play. Any photos or videos taken by Doug Miller 19 Inc or K&K Property Ventures LLC are sole property of Doug Miller 19 Inc. and K&K Property Ventures LLC and can be used in any advertisements, marketing or publications used to promote Rochester Lancers FC, Camps, Clinics, Training, Leagues or Tournaments.
Please be aware of the following policy that Glacier Ridge Sports Park will strictly follow: Once you sign up for one of our leagues full payment is required as there are limited spots to play in our leagues.
Release of Liability
I hereby warrant that my child is in good physical condition and is capable of participating in this program. I hereby authorize the Doug Miller 19 Inc d/b/a Rochester Lancers and K&K Property Ventures LLC staff to act for me according to their best judgment in any emergency requiring medical attention for my child. I hereby waiver and release Doug Miller 19 Inc. and K&K Property Ventures LLC, its staff, and any associated facilities, from any and all liability for any injuries and illness' incurred during participation. I will be responsible for any and all costs of medical attention and treatment. Doug Miller 19 Inc. d/b/a Rochester Lancers is not responsible for personal items that are lost, stolen or damaged.
Sunday Youth League - $595*