Shootaz Soccer Academy Players Registration Form

Player details
Players Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Player's Phone Number
Age*
Preferred Method of Contact
Soccer Skill Level
intermediate, middle, high
Weight
Jersey Size*
Height
Jersey Number
Player’s Position
Sex

Parent / Guardian Information
Parent / Guardian Name*

First NameLast Name
Email*
example@example.com
Phone Number*
AGREEMENT - To Participate In Soccer

I understand;
1. That the rules and regulations that govern the game of soccer are in written form or explained by the coaching crew.
2. That there are inherent dangers involved in playing the game of soccer.
3. That I must be aware of the risk associated with playing soccer, including but not limited
to:
a) Collision with players or objects such as the goal post, bleachers etc.
b) Injuries caused by swinging of hands and elbows, sliding, tackles and errant thrown
or kicked balls.
c) Weather related injuries caused by humid and hot conditions.
d) Concussions.
I agree;
1. To obey the rules and regulations of the game of soccer.
2. To abide to the officiating of the game in matches and tournaments.
Signature*
Add Initials of first and last name
Date

MonthDayYear
Date
Waiver, Assumption of Risk and Consent

I understand that my child’s participation in the game of soccer may be dangerous and that my child should not participate unless he/she is in good physical and mental shape, and is medically able to train. I assume all the risk associated with participating in the game of soccer, including but not limited to, those generally associated with this type of activity.

I agree for my child’s participation in the game of soccer and for other arrangement made by Shootaz Soccer Academy like entertainment and recreation activities. I do hereby on behalf of my child, agree to indemnify Shootaz Soccer Academy coaches and employees or Training Facility from any and all claims from injuries or loss of any person or property which may arise out of a result from my child’s participation in the game of soccer in Shootaz Soccer Academy. I also grant permission for a doctor or emergency medical technician to administer emergency treatment to my child and permit for the use of photographs or videos made of the incident during the program that involved the participant.

I authorize Shootaz Soccer Academy to use my child’s photograph/video in any printed or digital publications for promotional purposes. Neither the coach nor any of the staff are responsible for the child prior to or after any scheduled program.
Signature*
Add Initials of first and last name
Date

MonthDayYear
Date
Parent/Guardian: By my signature above, I hereby certify that I have reviewed the above
Agreement for my child to participate and that he/she understands his/her responsibilities as a participant.

Medical Information
Name of Doctor*
Doctor's Phone Number*
Details of any known conditions, allergies etc (asthma, diabetes, epilepsy, foods):
Any medication being taken:*

YesNo
Any other special need, requirements/ directions that would be helpful for coaches to know about
Additional Emergency Contact Details (if the parent / Guardian cannot be reached)

First NameLast Name
Insured

YesNo
Phone Number

Release of Liability for Minor Participants
I have read, understood, and hereby agree to abide by the above guidelines*

YesNo

Return to Play | Training Day Survey
I have read, understood, and hereby agree to abide above guidelines*

YesNo

Club Policy
I have read, understood, and hereby agree to abide by the above Club policy.*

YesNo

Sign & Submit
Name*

First NameLast Name
Signature*
Add Initials of first and last name
Date*

MonthDayYear
Date
Should be Empty: