2022 Tryout Registration Form

Tryouts held at West Michigan Heat home field at 3435 Oak St, Hudsonville, MI.

NOTE: the field is behind Hudsonville Christian School on Hillcrest Road

Athlete 1 *

	First	Last	DOB \| Mon	Day	Year	Grade	Tryout

Athlete 2

	First	Last	DOB \| Mon	Day	Year	Grade	Tryout

Athlete 3

	First	Last	DOB \| Mon	Day	Year	Grade	Tryout

Athlete 4

	First	Last	DOB \| Mon	Day	Year	Grade	Tryout

Describe athlete allergies, chronic illness, or medical conditions? Describe or indicate NA *

Describe athlete inhaler instructions, if applicable.

Parent/Guardian

Parent/Guard. Name *

Parent/Guard Phone *

Parent/Guard. Address *

Parent/Guard E-mail *

Confirmation Email

How did you learn about West Michigan Heat? *

Emergency Contact *

	First	Last	Phone	Relationship
1
2

Insurance & Treatment Authorization

Is the athlete(s) covered by family medical insurance? *

yes no

West Michigan Heat is authorized to approve medical treatment *

yes no

Insurance Company

Insurance Card Image

Browse Files

Policy/Group Number

Participation Waiver

The above named student, has my/our permission to participate in the 2022 West Michigan Heat Soccer Tryouts. I/we will not hold any staff member or volunteer responsible in the case of an accident or injury. I/we give West Michigan Heat permission to seek any necessary medical treatment in the case of an emergency, if I/we (the parents/guardians) cannot be reached. I/we, the undersigned parent/guardian, assume complete responsibility for any injury or accident which may occur during or arising from my student's participation in the West Michigan Heat Tryouts. I/we hereby release, waive, indemnify, and hold harmless the club, sponsors, coaches, drivers, and all other persons and entities associated with the West Michigan Heat Soccer Club from any and all injury, loss, and/or damage to my student during soccer camp. In the event of injury or illness, I will be completely responsible for any and all resulting treatment costs. By typing our names below, I/we agree to the terms stated above.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Parent Signature *

Clear

Photo Release

I grant to West Michigan Heat Soccer Club and its representatives the right to photograph my child in connection with Heat Tryouts and to use and publish such photos in print or electronically with or without their name for any lawful purpose, including for publicity, web content and illustration.

I grant photo release for athletes within this registration *

Yes No

2022 West Michigan Heat Tryout Registration