TRYOUTREGISTRATIONFORM

DATE:_____________________________

PLAYERNAME:_____________________________________________________________BIRTHYEAR-_________________MALE()FEMALE()DOB(mm/dd):_____________________TRYOUT#____________________TryingoutforGoalKeeper:YES()NO()Parent/GuardianName(s):______________________________________________________________________________MothersDOB(DD/MM)_______________ADDRESS:_____________________________________________________CITY:___________________________________________________STATE:_____________ZIP:________________________PHONE:(H)____________________(C)_____________________EMAIL:_________________________________________INTERSTEDINPLAYINGCOMPETITIVE/TRAVELING?_____YES_____NORecognizingthepossibilityofphysicalinjuryassociatedwithsoccer,andinconsiderationfortheUSSF/USYouthSocceranditsaffiliatesacceptingtheregistrantforitssoccerprogramsandactivities(the“programs”),Iherebyrelease,discharge,and/orotherwiseindemnifytheUSSF/USYouthSoccer,ProstarSoccerClub,itscoaches,directors,andofficersanditsaffiliatedandfacilitiesutilizedforthe“programs”againstanyclaimbyoronbehalfoftheregistrantasaresultoftheregistrant’sparticipationinthe“programs”and/orbeingtransportedtoorfromthesame,whichtransportationIherebyauthorize.Iherebygiveconsenttohaveanathletictrainer,emergencymedicaltechnicianand/ordoctorofmedicineordentistryprovidemysonordaughterwithmedicalassistance,treatmentand/ortransportandagreetoberesponsiblefinanciallyforthereasonablecostsofsuchassistanceand/ortreatment.NameofParent/Guardian(print):__________________________________________________________________Signature:___________________________________________________Date:___________________________________

MEDICALRELEASE

Listanymedicalproblemorprohibitionplayerhas:

Allergies:

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