Team America Soccer Club

1
Are you registering an Individual or Family?* This field is required.
Individual
Family
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How many players are you registering?* This field is required.
1
2
3
4
5
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Player 1 - Name* This field is required.
First Name
Last Name
4
Player 2 - Name* This field is required.
First Name
Last Name
5
Player 3 - Name* This field is required.
First Name
Last Name
6
Player 4 - Name* This field is required.
First Name
Last Name
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Player 5 - Name* This field is required.
First Name
Last Name
8
Player 1 - Date of Birth* This field is required.
Date
Month
Day
Year
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Player 2 - Date of Birth* This field is required.
Date
Month
Day
Year
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Player 3 - Date of Birth* This field is required.
Date
Month
Day
Year
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Player 4 - Date of Birth* This field is required.
Date
Year
Month
Day
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Player 5 - Date of Birth* This field is required.
Date
Year
Month
Day
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Player 1 - Gender* This field is required.
Male
Female
Unspecified
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Player 2 - Gender* This field is required.
Male
Female
Unspecified
15
Player 3 - Gender* This field is required.
Male
Female
Unspecified
16
Player 4 - Gender* This field is required.
Male
Female
Unspecified
17
Player 5 - Gender* This field is required.
Male
Female
Unspecified
18
Player 1 - School* This field is required.
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Player 2 - School* This field is required.
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Player 3 - School* This field is required.
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Player 4 - School* This field is required.
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Player 5 - School* This field is required.
23
Parent/Guardian 1 - Name* This field is required.
First Name
Last Name
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Parent/Guardian 1 - Phone Number* This field is required.
25
Parent/Guardian 1 - Email* This field is required.
example@example.com
Confirm Email
26
Parent/Guardian 1 - Address* This field is required.
Street Address
Street Address Line 2
City
Please Select
Please Select
Alabama
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Kentucky
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Texas
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State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
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Barbados
Belarus
Belgium
Belize
Benin
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Bhutan
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Botswana
Brazil
Brunei
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Burkina Faso
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Cameroon
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Cape Verde
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Chad
Chile
China
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Cocos (Keeling) Islands
Colombia
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Cote d'Ivoire
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Cuba
Curaçao
Cyprus
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Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
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Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
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French Polynesia
Gabon
The Gambia
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Ghana
Gibraltar
Greece
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Laos
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Mali
Malta
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Montserrat
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Nagorno-Karabakh
Namibia
Nauru
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Nigeria
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Poland
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Qatar
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Romania
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Rwanda
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Samoa
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Slovenia
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eSwatini
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Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
27
Would you like to list a 2nd Parent/Guardian?* This field is required.
YESNO
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Parent/Guardian 2 - Name* This field is required.
First Name
Last Name
29
Parent/Guardian 2 - Phone Number* This field is required.
30
Parent/Guardian 2 - Email* This field is required.
example@example.com
Email Verified
Confirm Email
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code? or
Receiving the email may take a few minutes, thank you for your patience!
31
Would you like to list an Emergency Contact?* This field is required.
YESNO
32
Emergency Contact - Name* This field is required.
First Name
Last Name
33
Emergency Contact - Phone Number* This field is required.
34
WAIVER

As parent or guardian of the child registered hereon, we hereby approve his/her participation in this activity. I/we hereby assume all risks and hazards of such participation, including transport to and from the activity. I/we do hereby waive, release, absolve and agree to indemnify and hold harmless TASC, TAFC and Fairfax Sportsplex its directors, officers, supervisors, coaches, trainers, referees, and other participants and persons providing transportation to or from activities for any claim or right arising out of any injury to said child. I/we have read the foregoing release and agreement, understood it, and signed it voluntarily.

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WAIVER - Parent/Guardian Signature* This field is required.
Clear
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RELEASE

No player may be placed on a roster or allowed to participate in club activities, including games or practices, except as a legal guest player, unless they have registered online with the club and completed online payment for the seasonal year.

Regular club registration fee is $200 for one player or $300 for the family with more than one player. Parents must understand that this registration is for the full seasonal year. Each player is responsible to pay their pro-rata share of the team league fees (fall & spring), Fairfax County field use fee each season fields are used and uniform expenses.

I/we understand these fees are paid usually through the team. As parent or guardian of the child registered hereon, we hereby approve his/her participation in this activity and agree to pay our share of the fees mentioned above. We further agree to adhere to the Codes of conduct published by Team America and any activity or league in which our son/daughter participates. I/we hereby assume all risks and hazards of such participation, including transport to and from the activity. I/we do hereby waive, release, absolve and agree to indemnify and hold harmless TASC, TAFC, and Fairfax Sportsplex its directors, officers, supervisors, coaches, trainers, referees, and other participants and persons providing transportation to or from activities for any claim or right arising out of any injury to said. All registrations are for a full seasonal year commitment.

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RELEASE - Parent/Guardian Signature* This field is required.
Clear
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Calculate Price
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Referred ByOptional
40
Registration Fee* This field is required.Includes 3.3% Processing Fee
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