Free Agent League Registration Form

Free Agent - Registration Form

www.azcoedsoccer.com
Athlete Information
Player Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Year Born *
Home Phone *

Area Code Phone Number
Cell Phone

Area Code Phone Number
What League? *

Friday Nights (Verrado - Buckeye) Saturday Nights (Pioneer Park - Peoria)
E-mail *
Interested in Refing while your team not playing? (League pays $25 ea. game).

Yes No
Emergency Contact
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
Release of Liability

Although the safety of all sport activities is the primary concern, sport activities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the Big Goal Coed Soccer League and the persons in charge.
I have read and agree to the above conditions *

Yes No
Confirmation E-mail *
Signature *

Clear
Fee
prev next ( X )
Free Agent $ 60.00

Total $ 0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.