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Official Philadelphia Union Club Affiliate - Philadelphia, PA 19128

Roxborough United Soccer Club



When registering for any Roxborough United Soccer Club (RUSC) program, parents or guardians must accept the following release, waiver of liability and consent for emergency care.

I, the registrant, hereby agree and acknowledge the following:

(1) Recognizing the possibility of injury or illness, and in consideration for US Youth Soccer and members of US Youth Soccer accepting my child as a player in the soccer programs and activities of US Youth Soccer and its members (the “Programs”), I consent to my child participating in the Programs. Further, I hereby release, discharge, and otherwise indemnify US Youth Soccer, its member organizations and sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the Programs, against any claim by or on behalf of my child as a result of my child’s participation in the Programs, including being transported to or from the Programs. I hereby authorize the transportation of my child to or from the Programs.

(2) My child has received a physical examination by a licensed medical doctor and has been found physically capable of participating in the sport of soccer. I have provided written notice attached to this release setting forth any specific issue, condition, or ailment that my child has that may impact my child’s participation in the Programs. I give my consent to have an athletic trainer and/or licensed medical doctor or dentist provide my child with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and treatment.

(3) When necessary, I understand that an uploaded or provided photo will only be used for printing on a credential (i.e. ID, Pass Card, Roster) and will not be used for any other purposes without express consent. I consent to RUSC and its affiliates taking photographs, video recordings, and/or sound recordings in documenting the activities of RUSC’s programs and services. I hereby grant RUSC's and its affiliates’ permission to use the negatives, prints, motion pictures, video recordings, audio recordings, or any other reproduction of the same for RUSC and its affiliates’ educational and promotional purposes in manuals, on flyers, the internet, or other publications.

(4) My child and my child’s parents and guardians will abide by the rules, policies, procedures and protocols as provided by US Youth Soccer and members of US Youth Soccer, including RUSC and all affiliated member organizations.

(5) I understand and give permission for my child to participate in practices and games where they may be on the field with players of younger or older ages.  I understand and accept there may be risks involved when playing with players of different ages.  I am aware that if I do not accept such risks I may remove my child from the field.

(6) I understand that no jewelry of any kind may be worn during play–no bracelets, necklaces, earrings or rings. Players may not wear beads, barrettes or other hard/sharp items. Newly pierced ears may not be taped. Players may not participate with casts or splints of any kind. There are no exceptions to this rule for the safety of all our players.

I have read this release and waiver of liability and fully understand its terms. I understand that I waive substantial rights by electronically signing this form. I agree to waive all such rights above including the right to file a legal action or assert a claim for personal or physical injury or death of any kind. I electronically sign this release form freely of our own free will.

Contact Us

Roxborough United Soccer Club

P.O. Box 35110 
Philadelphia, Pennsylvania 19128

Email Us: [email protected]
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