Soccer Registration Form

Child's Name *

Child's Age *

Child's Gender *

Child's Shirt Size *

Parent's Name *

Address *

City *

State *

ZIP / Postal Code *

Phone *

Email

Special Needs / Medical Conditions

Please list any special needs or medical conditions this participant has.

I Agree

By checking the box above, I am acknowledging that I understand the inherent risk of injury in participation in this sports program and verify that my child is medically fit to participate. I give my permission to the supervisors of this program to take the proper steps in case my child is in need of emergency medical attention. I also release the sponsoring groups and their agents from any and all claims arising from this child's participation in this activity.