Soccer Registration Form

CSA Soccer Registration
You will need to fill out one registration per child. Once you have completed the regsitration you can start a new registration form for the next child.
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Male/Female*
I wish to practice in:
All games played at Bandera Sports Complex
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
UNIFORM INFORMATION
Youth Shirt
Youth Shorts
Adult Shirt
Adult Shorts
MEDICAL INFORMATION
Physician Name

First NameLast Name
Phone Number

Area CodePhone Number
Medical Concerns
By submitting the form, I, as the parent/guardian of the registrant, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may given under whatever conditions are necessary to preserve the life, limb, or well-being of registrant.

By submitting the form, I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the CSA, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the CSA, accepting the registrant for its soccer programs and activities (the "Programs"). I hereby release, discharge and/or otherwise indemnify the CSA, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the Programs, against any claimby or on behalf of the registrant as a result of the registrant's participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.
Should be Empty:

CSA Soccer Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

UNIFORM INFORMATION

MEDICAL INFORMATION