Team

Major League Professional Futsal and Youth Academy

CINCinnati FUTSAL

Alexandr Istrati

Home Town: Moldova

Kevin Kohnescher

Home Town

CINCINNATI FUTSAL

DOB: *

Eddie Jimenez

Home Town:

Ademir Asmat

Home Town:

Corey Whisenhunt

Home Town: Dayton, Ohio

Bret Marshall

Home Town:

Austin Ward

Home Town: Cincinnati, Ohio

Rashawn Lamar

Home Town: Atlanta, GA

Coach/Player

Waiver *

I/we hereby agree that Cincy Futsal including Clinics/Camps instructors/coaches shall not be liable for any injury or loss which myself or my child(ren) may sustain while participating in this soccer training, and I agree to indemnify and to hold harmless Cincy Futsal including Combine/Clinics/Camps Training and any or all of the instructors/coaches from any claim whatsoever. I/We, the undersigned for ourselves, our heirs, executors and administrators waive, release and forever discharge Cincy Futsal including Combine/Clinics/Camps and its staff, officers, agents, employees, representatives and successors and assigns of and from all rights and claims for damages, injury or loss to person or property which may be sustained or occur while participating in training activities or while at training, whether or not damages, injury or loss is due to negligence. Cincy Futsal reserves all rights to use photographs for marketing purposes. If you would like your child excluded from any marketing materials you must contact us via email before the player participants in any event.

Emmanuel Agyei

Home Town:

Player or Parent/Guardian Full Name: *

Mychal Young

Home Town:

Matt Brienes

Home Town:

Player if under 18 Parent/Guardian E Signature *

Roger Straz

Home Town: Des Plaines, IL

Coach/Player

Joe Dills

Home Town:

Ryan Tucker

Home Town: Canton, Ohio

Will Bencic

Home Town:

E Signature confirmation *

PLACING YOUR INITIALS IN THE BOX ABOVE AND CHECKING THE CONFIRM E-SIGNATURE YOU ARE VERIFYING THAT YOU ARE THE PARENT AND OR LEGAL GUARDIAN OF THE ABOVE MENTIONED PLAYER AND AGREE TO THE ABOVE MENTIONED TERMS.