MERCK SOCCER LEAGUE
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2025 Registration

Step 1 of 4
Registrant Information

Registrant's First Name:

Registrant's Last Name:

Registrant's Birthdate:

Registrant's Gender: Male   Female

Program: 

Registrant's Ability Compared to Peers: Used to help us balance teams

Medical or Physical Conditions:Please let us know if the registrant has any medical or physical issues that we should be aware of (leave blank otherwise)

Are you a returning player?: 

Which team are you playing for? (If you do not know, please select free agent): 

What size shirt do you wear?: 

Are you a Merck Employee or an immediate family member of a Merck Employee?: 

Emergency Contact: 

Emergency Phone Number: xxx-xxx-xxxx

Contact Information

Street:

City:

State:

Zip/Postal Code:

Home Phone: xxx-xxx-xxxx

Mobile Phone: xxx-xxx-xxxx

Mobile Phone Carrier: Used to send you text messages

I permit Merck Soccer League to send SMS messages to this mobile phone.

Primary Email Address: 

Release Statement

To complete your registration for this registrant, you must agree to the following Release Statement by checking the box below.

Please read carefully. This is a legally enforceable waiver of rights.

MERCK & CO., INC
RELEASE AND INDEMNIFICATION

I, ___________________________, acknowledge that I have voluntarily applied to
participate in ______________________________ (“Activity”). I understand that
participation in the Activity involves numerous risks and dangers including, but not
limited to one or more of the following:
• Accident, injury or illness;
• Lack of access to rapid evacuation or availability of medical supplies;
• The adequacy of medical attention once provided;
• Physical exertion for which I am not prepared;
• Property loss or damage;
• The hazards of traveling in remote areas;
• The forces of nature;
• Negligence (but not willful or fraudulent conduct) on the part of the Activity
providers, or others; and
• Other risks or hazards not identified above.
In consideration of my participation in the Activity, I release, waive, discharge, and
covenant not to sue Merck & Co., Inc., its subsidiaries, affiliates, and agents and its and
their employees, officers and directors (hereinafter “MERCK”) for any and all liability,
claims, demands, actions, or causes of action arising out of any damage, loss, injury, or
death to me or my property while participating in the Activity.
I further agree to indemnify and hold harmless MERCK from any and all liabilities, costs,
and expenses, including attorney's fees, arising out of or relating to my participation in
the Activity.
I understand that this waiver and release of liability is intended to be as broad and
inclusive as permitted by applicable law and that if any portion of this waiver is held
invalid, the remainder will continue in full force and effect.
By signing below, I acknowledge that I have carefully read this Release and
Indemnification and fully understand that it is a release of liability. I also understand that
by signing, I am waiving substantial legal rights.
I HEREBY CERTIFY THAT I AM OVER AGE 18 AND VOLUNTARILY AGREE TO THE
TERMS AND CONDITIONS STATED ABOVE.

SIGNATURE________________________________
DATED THIS _______ DAY OF _______________ 20__.

I Agree

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