Soccer Routes - Participant Registration Form printable pdf download

Soccer Routes - Participant Registration Form

SOCCER ROUTES, INC.

PARTICIPANT REGISTRATION FORM

nstructions for filling out this form: Print out a copy of this form. Fill it out completely and make sure it is signed by appropriate

Parent(s)/Guardian(s). Hand completed form to the nearest Coach.

FIRST NAME

LAST NAME

ADDRESS

CITY

STATE

ZIP CODE

BIRTH DATE

MALE

FEMALE

EXACT AGE OF CHILD ________

ALLERGIES________________________________________________

PARENT(S) / GUARDIAN(S) NAME(S)

PLEASE PRINT

E-MAIL ADDRESS(ES)

HOME PHONE

WORK OR CELL PHONE

HOW DID YOU HEAR ABOUT US?____________________________________________________________________

HAVE YOU (HEARD OF OR) APPLIED MOMMY MARKETING FOR MONEY OFF OF YOUR BILL, AND TO RECEIVE A

CHECK FROM US? ________________________________________________________________________________

HAVE YOU LOOKED INTO ANALYTICAL STAT COACHING? (SERIOUS PLAYERS – IF YOUR CHILD WANTS TO PLAY

HIGH SCHOOL/COLLEGE___________________________________________________________________________

Release Statement

NOTE: This statement MUST be signed by Parent/Guardian for Player.

I, the parent/guardian of registrant, a minor or adult registrant of legal age, agree that I and the registrant will abide by the rules of

SOCCER

ROUTES

(INC.), and its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with

soccer and in consideration for SOCCER

ROUTES

(INC.) accepting the registrant for its soccer programs and activities (“the

Programs”), I hereby release, discharge and/or otherwise indemnify SOCCER

ROUTES

(INC.), its affiliated organizations and

sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any

claim by or on behalf of the registrant as a result of registrant’s participation in the Programs, and/or being transported to or from the

same which transportation I hereby authorize

PARENT/GUARDIAN OR ADULT SIGNATURE

DATE

Soccer Routes - Participant Registration Form