From the Volunteer Application Form: (en Espaņol)

DISCLOSURE STATEMENT
I have read and understand that I may be disqualified and prohibited from serving as an employee or volunteer of AYSO if, among other things, I have:
1) Been convicted (includes crimes of record which have been expunged and pleas of "no contest") of a crime of child abuse, sexual abuse of a minor, physical abuse, causing a child's death, neglect of a child, murder, manslaughter, felony assault or any assault against a minor, kidnapping, arson, criminal sexual conduct, prostitution related crimes, controlled substance crimes, or any other felony;
2) Been adjudged liable for civil penalties or damage involving sexual, physical or verbal abuse of children;
3) Been subject to any court order involving any sexual, physical or verbal abuse of a minor, including, but not limited to, a domestic or protection order;
4) Had parental rights terminated;
5) A history with another organization (volunteer, employment, etc.) of complaints of sexual, physical or verbal abuse of minors;
6) Resigned, been terminated or been asked to resign from a position, whether paid or unpaid, due to a complaint(s) of sexual, physical or verbal abuse of minors;
7) A history of behavior that indicates I may be a danger to children in the AYSO program.

Do any of the statements on reverse side apply to you? Yes No
If you checked "YES" to any disclosure item, please indicate number(s)___________ and attach an explanation on seperate page

DISCLAIMER, ASSUMPTION OF RISK AND WAIVER: For myself and on behalf of my heirs, assigns and next of kin, I acknowledge that participation in soccer necessarily involves travel, participation on advers field conditions, contact with considerable force, and risk of severe, permanent physical injury including bruises, scrapes, strained, sprained or torn muscles, tendons or ligaments, broken bones, dislocation of joints, concussion, brain damage, nerve and spinal cord injury, paralysis and death. For myself, and on behalf of my heirs, assigns and next of kin, I willingly and voluntarily accept and assume all such risks of participation.

I further acknowledge that the American Youth Soccer Organization ("AYSO") is primarily administered by volunteers rather than paid professionals.

In consideration of accepting the registration and permitting my voluntary participation in its programs, for myself and on behalf of my heirs, assigns and next of kin, I hereby release, discharge and agree to hold harmless AYSO, its employees, volunteers, officials, sponsors and other representatives from any and all claims, demands, costs, expenses and compensation arising out of or in any way related to any injury or other damage that may result to me while participating in any AYSO-sponsored event, including any physical or other injury caused by the negligence of any such person while performing his/her duties at any time.

ACKNOWLEDGMENT AND CONSENT: I acknowledge receipt of the Soccer Accident Insurance pamphlet and I understand the terms of the Plan. I acknowledge that AYSO may compile and use addresses and soccer photographs of me for any purpose whatsoever. I consent to such uses and hereby waive all rights to compensation.

I HAVE READ THE ABOVE DISCLOSURE STATEMENT, WAIVER, CONSENT AND RELEASE OF LIABILITY, DISCLAIMER, ASSUMPTION OF RISK AND WAIVER, AND ACKNOWLEDGMENT AND CONSENT AGREEMENTS, FULLY UNDERSTAND THE TERMS OF EACH, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY MY SIGNING THIS FORM AND AGREEING TO THESE TERMS, AND I SIGN THIS FORM AND AGREE TO THESE TERMS FREELY AND VOLUNTARILY AND WITHOUT INDUCEMENT OF ANY KIND.

Signature: __________________________________ Date: ______________________

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