Registration

Email Address for Registration:*
Relationship to Child*

Player's Name:*
Date of Birth:*
Gender:* ---MaleFemale
Street Address:*
City & Zip Code:*
Home Phone:*


Age Group:*---Boys U10 - U11Boys U12 - U13Boys U14 -U 15Boys U16 - U18

Will you be playing town soccer in the Fall?* ---YesNoNot Sure
If so, what town?*

Mother's Cell Phone:
Mother's Email:
Father's Cell Phone:
Father's Email:

Previous Club Teams

Primary Care Physician Name*
Primary Care Physician Phone*

Emergency Contact Name*
Emergency Contact Phone*

Child's T-shirt Size

Email Address for Release:*
Player's Name*
Relationship to Child*

I give permission to staff of World Class Soccer Academy Clinic to give first aid, medication, and/or sunscreen as needed.* ---YesNo

I give permission to have my child's photograph used in future WCSAC promotions. (No children's names are ever used)* ---YesNo

Please upload or bring in a current health form from your child's primary care physician.

I, as parent/guardian of the named child specifically request that my child be permitted to participate in the World Class Soccer Academy Clinic. I understand that in connection with this training there is a risk of injury and make this request fully aware of such risk. I specifically agree, on consideration of my child's participation, to release, discharge, and otherwise indemnify all of the officers, coaches, agents and/or others involved in connection with participation in this program against any claim by or on behalf on my said child as a result of his/her participation.I agree