World Soccer Academy Registration Form

Please fill out and print this form

Player's Name

Address

City

Postal Code

Home phone

{options}

Date of Birth (YYYY-MM-DD)

Medical Conditions

Emergency Name

Emergency Number

Youth T-Shirt size

Small

Medium

Large

Extra-Large

PARTICIPANT/PARENT/GUARDIAN ACKNOWLEDGMENT AGREEMENT

I hereby grant the above mentioned applicant permission to participate in the above programs. I agree to allow WORLD SOCCER ACADEMY to contact emergency personnel on behalf of the applicant in the result of any injuries incurred by the applicant while participating in their programs. I agree to release and indemnify WORLD SOCCER ACADEMY and its staff members from any and all claims for loss, injury or damage to persons and property while participating in this program or traveling to and/or from this program. I understand that WorldSoccer Academy retains the right to use any photographs, videotapes, motion picture recording or any other record of the event for publicity, advertising or any legitimate purpose.

REGISTRATION IS NOT VALID UNLESS BELOW COMPLETED BY PARENT OR GUARDIAN FOR UNDERAGE PARTICIPANTS.

Name of Parent/Guardian (or Participant if adult)

Date Today (YYYY-MM-DD)

Signature