INSURANCE WAIVER FOR DUAL PLAY

I understand that my child will be playing in non-CYSA, (California Youth Soccer Association- North) sanctioned games during the time period of:________ to:_________. I further understand that there is no CYSA Insurance being provided during these non-sanctioned event/events. It is my responsibility to determine if my child should play in these events without the approval of CYSA and it is my responsibility to determine what if any insurance is available to my child during the above referenced events. If I wish to have my child covered by medical insurance during these event/events it is my responsibility to obtain insurance for my child.

Players Name:________________________________________ Date of Birth:_________________________

CYSA Player ID#:________________________________________________________________________

Name of Team:___________________________________________________________________________

Parent's/Guardian Name: (Please Print)_______________________________________________________________________

Address:__________________________________________________  Phone Number: (_____)_________________________

Be sure you understand what this document means before you sign it.

Parent/Guardian Signature:______________________________________________________________________________

Date:_________________________________________________________________________________________________